Effect of bispectral index-guided anaesthesia versus standard practice on recovery after general anaesthesia in children: A systematic review and meta-analysis.

Background and aims: Accurate assessment of anaesthesia depth in children is essential for individualised anaesthetic monitoring and remains a considerable challenge in clinical practice. The bispectral index (BIS), a widely used clinical tool for monitoring anaesthesia depth, has been subject to controversy regarding its effectiveness in improving recovery quality in children after anaesthesia. This meta-analysis aimed to compare the impact of BIS-guided anaesthesia versus traditional anaesthesia depth monitoring on postoperative recovery quality in children undergoing general anaesthesia.

Methods: A comprehensive search of databases, including PubMed, Cochrane Library, Embase, Web of Science, Scopus, and OVID, for articles published up to June 2024, updated in May 2025 was conducted. Randomised controlled trials comparing BIS-guided titration of anaesthetic agents to standard practice using haemodynamic parameters and clinical signs were analysed. Outcomes assessed included surgical duration, anaesthesia duration, end-tidal sevoflurane concentration, propofol consumption, first response time, eye-opening time, extubation time, post-anaesthesia emergence agitation scores, and post-anaesthesia care unit (PACU) stay duration.

Results: Compared to traditional anaesthesia depth monitoring, children monitored with BIS during anaesthesia maintenance had significantly lower end-tidal sevoflurane concentrations. In addition, BIS monitoring was associated with significantly shorter times for first response, eye-opening, extubation, and PACU stay. Other outcome measures did not show significant differences.

Conclusions: BIS monitoring in children undergoing general anaesthesia is associated with improved recovery quality, as evidenced by reduced times for first response, eye-opening, extubation, and PACU stay.