Summary
Ambulatory surgery has evolved considerably over the past two decades, with more complex procedures being performed, and more ASA class III patients being eligible. This progress, while driven partly by health care economics, has evolved through expanded scientific research in all areas of ambulatory anesthesia. Evolution of anesthetic pharmacology, including new drugs and better understanding of their complex interactions, as well as more targeted regional anesthetic techniques, have had an enormous impact. Another key area of development is facilitation of patient recovery and discharge from the post anesthesia care unit (PACU) and step-down unit, or ambulatory surgical unit (ASU).
Ambulatory surgeries in children require an anesthetic regimen that provides fast recovery, fewer side effects, and high quality of recovery. Anesthesia guided by cerebral monitoring for anesthetic depth, such as bispectral index (BIS), been demonstrated to reduce anesthetic concentration, facilitate earlier recovery, improve quality of recovery, and prevent awareness.
The BIS uses a combination of EEG sub parameters of EEGs to demonstrate specific ranges for varying phases of anesthetic effect. These parameters were then combined to form the optimum configuration for monitoring of the hypnotic state.
The BIS is displayed as a dimensionless number between 0 and 100, with the lower numbers corresponding to deeper levels of hypnosis.
The BIS values 100, 80, 60, 40, and 0 represent awake, sedation, general anesthesia, deep hypnosis and an isoelectric electroencephalogram, respectively.
Sevoflurane is most commonly used inhalation anesthetics today in children because it is especially desirable for mask induction in children because of its patient acceptance and rapid onset.
The use of volatile anesthetics is associated with frequent emergence delirium in children screaming, disorientation, and kicking. This often leads to increased length of hospital stay and medical intervention to prevent increased bleeding from surgical sites, accidental removal of intravenous lines, and wound pain.
Postoperative nausea and vomiting (PONV) is another common adverse effect of volatile anesthetics. The use of cerebral monitoring-guided anesthesia can decrease postoperative nausea and vomiting.
The aim of this study was to evaluate the impact of BIS guided anesthesia, as compared with standard clinical practice, and to investigate the quality of recovery, including emergency delirium, PONV, parental satisfaction and sevoflurane concentration/consumption.
This study was prospective, comparative, blind, randomized clinical trial which done at Benha University Hospitals. Patients were randomized into two equal groups:
Group I: Depth of anesthesia guided by clinical parameters (standard practice [SP] group).
Group II: Depth of anesthesia guided by BIS (BIS group).
The results of our present study can be summarized as follows:
There were no statistically significant differences between Group C and Group BIS as regarding age, weight, Time of surgery (min.), Time of anesthesia (min.), Sex and ASA.
There was no statistically significant difference between Group C and Group BIS as regarding type of surgery.
Mean value of time for extubation (sec.) was statistically significantly higher among standard practice group than Group BIS.
Mean value of time to discharge to PACU (sec.) was statistically significantly higher among standard practice group than Group BIS.
Mean value of PACU time (min.) was statistically significantly higher among standard practice group than Group BIS.
Mean value of PAED at Base line, 5, 10 and 15 min was statistically significantly higher among Group C than Group BIS. Mean value of PAED at 20, 25 and 30 min was not statistically significantly among Group C than Group BIS.
There were no statistically significant differences between Group C and Group BIS as regarding hear rate at Base line, 5 min, 10 min, 15 min, 20 min, 25 min and 30 min.
There were no statistically significant differences between Group C and Group BIS as regarding MAP at Base line, 5 min, 10 min, 15 min, 20 min, 25 min and 30 min.
Mean value of End tidal sevoflurane conc. was statistically significantly higher among Group C than Group BIS.
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