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Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries

Le titrage de l’isoflurane à l’aide du BIS peut hâter la récupération des patients âgés en chirurgie orthopédique

Canadian Journal of Anesthesia volume 49, pages 13–18 (2002)Cite this article

Abstract

Purpose

This study was designed to investigate the effect of bispectral index (BIS) monitoring on the recovery profiles, level of postoperative cognitive dysfunction, and anesthetic drug requirements of elderly patients undergoing elective orthopedic surgery with general anesthesia.

Methods

Sixty-eight patients over the age of 60 were randomized into one of two groups. In the standard practice (SP) group, the anesthesiologists were blinded to the BIS value, and isoflurane was titrated according to standard clinical practice. In the BIS group, isoflurane was titrated to maintain a BIS value between 50–60.

Results

The total isoflurane usage was 30% lower in the BIS group compared to the SP group (5.6 ± 3 vs 7.7 ± 3 mL, P < 0.05). The time to orientation was faster in the BIS group compared to the SP group (9.5 ± 3vs 13.1 ± 4 min,P < 0.001). There were no differences in the postoperative psychometric tests between the two groups.

Conclusions

There was no difference in the level of postoperative cognitive dysfunction between the two groups. However, titration of isoflurane using the BIS index decreased utilization of isoflurane and contributed to faster emergence of elderly patients undergoing elective knee or hip replacement surgery.

Résumé

Objectif

Rechercher l’effet du monitorage par l’index bispectral (BIS) sur les profils de récupération, le niveau de déficit cognitif postopératoire et les besoins d’anesthésiques chez des patients âgés qui subissent une intervention orthopédique non urgente avec anesthésie générale.

Méthode

Soixante-huit patients de plus de 60 ans ont été répartis au hasard en deux groupes. Pour ceux du groupe de pratique courante (PC), la valeur du BIS n’était pas connue des anesthésiologistes et l’isoflurane a été titré selon les normes de la pratique clinique. Pour les patients du groupe BIS, l’isoflurane a été titré de façon à maintenir un BIS entre 50 et 60.

Résultats

L’utilisation totale d’isoflurane a été plus basse de 30 % dans le groupe BIS, comparé au groupe PC (5,6 ± 3 vs 7,7 ± 3 mL, P < 0,05). Le retour à la conscience a été plus rapide dans le groupe BIS, comparé au groupe PC (9,5 ± 3 vs 13,1 ±4 min, P < 0,001). Les tests psychométriques postopératoires n’ont présenté aucune différence intergroupe.

Conclusion

Le niveau de déficit cognitif postopératoire n’était pas différent d’un groupe à l’autre. Cependant, le titrage de l’isoflurane à l’aide de l’index BIS a permis de réduire l’utilisation d’isoflurane et a favorisé une récupération plus rapide chez des patients âgés qui subissent la mise en place d’une prothèse totale de hanche.

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Affiliations

  1. Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada

    Jean Wong, Dajun Song, Hannah Blanshard, Deidre Grady & Frances Chung

Authors
  1. Jean Wong
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  2. Dajun Song
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  3. Hannah Blanshard
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  4. Deidre Grady
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  5. Frances Chung
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Corresponding author

Correspondence to Jean Wong.

Additional information

Supported in part by a grant from Aspect Medical, Newton, MA, USA.

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Wong, J., Song, D., Blanshard, H. et al. Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anesth 49, 13–18 (2002). https://doi.org/10.1007/BF03020413

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  • DOI: https://doi.org/10.1007/BF03020413

Keywords

  • Sevoflurane
  • Desflurane
  • Minimum Alveolar Concentration
  • Bispectral Index
  • Postoperative Delirium