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AMBULATORY ANESTHESIA

The Effect of Bispectral Index Monitoring on End-Tidal Gas Concentration and Recovery Duration After Outpatient Anesthesia

Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington

Address correspondence to D. J. Pavlin, Department of Anesthesiology, University of Washington, 1959 NE Pacific, Seattle, WA 98195.

We performed this study to determine whether instituting monitoring of bispectral index (BIS) throughout an entire operating room would affect end-tidal gas concentration (as a surrogate for anesthetic use) or speed of recovery after outpatient surgery. Primary caregivers (n = 69) were randomly assigned to a BIS or non-BIS Control group with cross-over at 1-mo intervals for 7 mo. Data were obtained in all outpatients except for those having head-and-neck surgery. Mean end-tidal gas concentration and total recovery duration were compared by unpaired t-test. Overall, 469 patients (80%) received propofol for induction and sevoflurane for maintenance. This homogeneous group was selected for statistical analysis. Mean end-tidal sevoflurane concentration was 13% less in the BIS group (BIS, 1.23%; Control, 1.41%; P < 0.0001); differences were most evident when anesthesia was administered by first-year trainees. Mean BIS values were 47 in the BIS-Monitored group. Total recovery was 19 min less with BIS monitoring in men (BIS group, 147 min; Controls, 166 min; P = 0.035), but not different in women. We conclude that routine application of BIS monitoring is associated with a modest reduction in end-tidal sevoflurane concentration. In men, this may correlate with a similar reduction (11%) in recovery duration.

IMPLICATIONS: Adoption of Bispectral index monitoring throughout an entire operating room was associated with use of lesser concentrations of sevoflurane to maintain anesthesia and reduced recovery duration in men undergoing general anesthesia for ambulatory surgery.

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