Dora Alexandra Carreira de Oliveira, Júlia Dos Santos Monteiro, Nickolas Ricardo de Macêdo, Arthur Henrique Tavares Costa Santos, Sílvia Maria Rosa Neves
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引用次数: 0
Abstract
Introduction: The bispectral index (BIS) parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding its benefits in children. We aimed to perform a systematic review and meta-analysis to determine whether BIS is advantageous for pediatric patients undergoing general anesthesia.
Methods: PubMed, Embase, and Cochrane Library were systematically searched for randomized controlled trials (RCTs) comparing BIS-guided anesthesia vs. general anesthesia guided only by clinical parameters in children undergoing surgeries. We computed mean difference (MD) for continuous outcomes and risk ratio (RR) for binary outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using I² statistics. Statistical analyses were performed using R Software, version 4.2.3.
Results: We included 10 RCTs, comprising 1028 participants, of whom 536 (52%) underwent BIS-guided general anesthesia. Compared with general anesthesia guided solely by clinical parameters, BIS was associated with a lower time for airway device removal (MD -1.32 minutes; 95% CI -2.26 to -0.37; p < 0.01), recovery time (MD -2.67 minutes ; 95% CI -3.70 to -1.65; p < 0.01), PACU stay duration (MD -5.51 minutes; 95% CI -10.64 to -0.38; p = 0.04), and ET sevoflurane concentration (MD -0.49%; 95% CI -0.67 to -0.32; p < 0.01). The BIS guided group also showed a significantly longer time with an adequate BIS compared with the standard care group (MD 22.49%; 95% CI 17.80 to 27.18; p < 0.01). There were no differences between groups in anesthetic consumption, mean BIS during anesthesia, Pediatric Anesthesia Emergence Delirium (PAED) score at 10 minutes, and at 30 minutes.
Conclusions: In children, BIS monitoring during general anesthesia limited the exposure to volatile anesthetics and is associated with better recovery outcomes.
Registration: PROSPERO database under protocol number CRD42024607202 (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607202).
简介：双谱指数（BIS）参数用于指导全麻滴定；然而，关于它对儿童的益处，许多研究显示出相互矛盾的结果。我们的目的是进行系统回顾和荟萃分析，以确定BIS是否有利于接受全身麻醉的儿科患者。方法：系统检索PubMed、Embase和Cochrane图书馆的随机对照试验（rct），比较bis引导麻醉与仅由临床参数引导的全麻在儿童手术中的应用。我们计算了连续结局的平均差异（MD）和二元结局的风险比（RR），并采用95%置信区间（ci）。采用I²统计量评估异质性。采用R软件4.2.3版本进行统计分析。结果：我们纳入了10项随机对照试验，包括1028名参与者，其中536名（52%）接受了bis引导的全身麻醉。与仅由临床参数指导的全麻相比，BIS与更短的气道装置移除时间相关（MD -1.32分钟；95% CI -2.26至-0.37;p）结论：在儿童中，全麻期间BIS监测限制了挥发性麻醉剂的暴露，并与更好的恢复结果相关。注册：PROSPERO数据库，协议号CRD42024607202 （https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607202）。
期刊介绍：
Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.
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