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1ISG-015 Evaluation of bispectral index monitoring in general anaesthesia through a health technology assessment method: a possible introduction in clinical practice in an Italian hospital?
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  1. E Guido1,
  2. ME Borghesi2,
  3. A Saccardi2
  1. 1University of Milan, Specialisation School in Hospital Pharmacy, Milan, Italy
  2. 2Asst Carlo Poma-Mantova, Hospital Pharmacy, Mantova, Italy

Abstract

Background and importance International guidelines suggest evaluation of clinical signs to guide the dosages of anaesthetic agents in order to achieve the basic goals of anaesthetic management. The use of the bispectral index (BIS) as standard practice might be useful for anaesthesia management by reducing the risk of intraoperative awareness (0.1–0.2% of the surgical population), consumption of anaesthetic agents, recovery time and total cost of anaesthesia.

Aim and objectives The objective of the study was to assess the efficacy of BIS guided anaesthesia monitoring for its potential introduction as standard practice.

Material and methods The study was conducted from January 2008 to July 2019, using the following databases: PubMed, Cochrane Library, ECRI and NICE. The articles included meta-analyses, randomised control trials, health technology assessment (HTA) reports and guidelines for BIS guided monitoring versus clinical signs as standard practice during general anaesthesia in adult patients. The evaluation was conducted according to the scheme reported in the sub annex G of Lombardy region Resolution XI/1046 which describes methods for the systematic research and critical analysis of the literature sources and the drawing up of an HTA report.

Results We reviewed 18 articles to analyse the benefits in terms of more reliable statistical evidence and cost effectiveness. BIS reduced the risk of intraoperative awareness in high risk patients by 80% (OR=0.24, 95% CI 0.12, 0.48). Furthermore, BIS reduced discharge time from postanaesthesia care units by about 23 mins (95% CI −31.01, −13.69; I²=20%), postoperative nausea and vomiting by 12%, risk of postoperative cognitive disorders at 3 months after extubation by 3% (95% CI −0.05, −0.00; I²=52%) and risk of postoperative delirium by 6% (95% CI −0.10, −0.03; I²=11%).

Conclusion and relevance BIS guided monitoring reduced the risk of intraoperative awareness in high risk patients under intravenous general anaesthesia. Furthermore, BIS was effective in reducing consumption of anaesthetic agents, time to discharge from postanaesthesia care units and postoperative adverse events. It remains to be clarified whether BIS technology is cost effective, considering the low prevalence of intraoperative awareness, and whether it represents a real benefit in perioperative and postoperative preventable adverse events. The costs of preventable adverse events should be evaluated at a single healthcare facility, considering the long term benefits.

References and/or acknowledgements 1. https://www.ncbi.nlm.nih.gov/pubmed/24937564

2. https://www.eahp.eu/sites/default/files/abstract_book_-_bar19_-_updated.pdf

3. https://www.ncbi.nlm.nih.gov/pubmed/23962378

No conflict of interest.

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