Cochrane · systematic review · CD003843
Bispectral index for improving intraoperative awareness and early postoperative recovery in adults
Lewis, SR, Pritchard, MW, Fawcett, LJ, et al. · Cochrane Database of Systematic Reviews · 2019 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
8
current version
GRADE rated
6
No studies
2
Included studies
NR
No studies 2 · 25%Ungraded 0 · 0%Very low 0 · 0%Low 6 · 75%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyBispectral index compared to clinical signs for improving intraoperative awareness and early postoperative recovery
Population: adults undergoing any type of surgery under general anaesthesia; types of anaesthesia included propofol, desflurane, isoflurane, and sevoflurane; people were either selected for being at high risk of intraoperative awareness, were unselected, or study authors did not report risk of awareness in the included participants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Occurrence of intraoperative awareness Time points of measure after surgery: 2 to 6 hours;12 hours; 1 day; 2 days; 3 days; 14 days; 30 days; or time point was not reported Measurement tools: simple questioning; interviews; or structured questionna... Bispectral index vs clinical signs | Peto OR 0.36 [0.21, 0.6] | 27 studies · 9765 participants | Low Downgraded: risk of bias, imprecision |
Time to eye opening (in minutes) Bispectral index vs clinical signs | no estimate extracted | 22 studies · 1494 participants | Low Downgraded: risk of bias, inconsistency |
Time to orientation (in minutes) Bispectral index vs clinical signs | no estimate extracted | 6 studies · 273 participants | Low Downgraded: risk of bias, imprecision |
Time to discharge from the PACU (in minutes) Bispectral index vs clinical signs | no estimate extracted | 13 studies · 930 participants | Low Downgraded: risk of bias, inconsistency |
BIS compared to ETAG for improving intraoperative awareness and early postoperative recovery
Population: adults undergoing any type of surgery under general anaesthesia; types of anaesthesia included propofol, desflurane, isoflurane, and sevoflurane; people were either selected for being at high risk of intraoperative awareness, were unselected, or study authors did not report risk of awareness in the included participants
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Occurrence of intraoperative awareness Time points of measure after surgery: 24 hours; 24 to 72 hours; 72 hours; 30 days; 18 hours after extubation in the ICU Measurement tools: structured interviews; or structured questionnaire BIS vs ETAG | Peto OR 1.13 [0.56, 2.26] | 5 studies · 26572 participants | Low Downgraded: risk of bias, imprecision |
Time to eye opening BIS vs ETAG | no estimate extracted | NR | No studies |
Time to orientation BIS vs ETAG | no estimate extracted | NR | No studies |
Time to discharge from the PACU (in minutes) BIS vs ETAG | no estimate extracted | 1 study · 15452 participants | Low Downgraded: imprecision |
Bispectral index versus standard practice (risk of awareness in surgical patients with high risk of awareness) for improving anaesthetic delivery and postoperative recovery
Population: patients for improving anaesthetic delivery and postoperative recovery
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Awareness in surgical patients with high risk of recall awareness ‐ using clinical signs as the guide in standard practice Bispectral index vs standard practice (risk of awareness | OR 0.24 [0.12, 0.48] | 4 studies · 7761 participants | Moderate Downgraded: inconsistency |
Awareness in surgical patients with high risk of recall awareness ‐ using end tidal anaesthetic gas as the guide Bispectral index vs standard practice (risk of awareness | OR 1.13 [0.56, 2.26] | 4 studies · 26530 participants | Low Downgraded: inconsistency |
Bispectral index versus standard practice for reducing risk of intraoperative awareness in surgical patients with high risk of awareness
Population: surgical patients with high risk of recall awareness
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
awareness in studies using clinical signs as a guide in the standard practice Bispectral index vs standard practice | OR 0.24 [0.08, 0.69] | 2 studies · 2493 participants | High |
awareness in studies using end‐tidal gas as a guide in the standard practice Bispectral index vs standard practice | OR 1.01 [0.14, 7.16] | 2 studies · 1981 participants | Moderate |