The Value of Auditing the Frequency of Inhalational Anesthetics With a Combination of Very Low Bispectral Index and High Fraction of the Age-Adjusted Minimum Alveolar Concentration
2024

Auditing Inhalational Anesthetics and Anesthetic Depth

Sample size: 8566 publication Evidence: high

Author Information

Author(s): Muacevic Alexander, Adler John R, Dexter Franklin, Epstein Richard H, Marian Anil A

Primary Institution: University of Iowa

Hypothesis

A substantive percentage of cases (>10%) have long (≥15 minutes) periods having the combination of MAC fraction >1.0 and BIS <35.

Conclusion

The study recommends auditing the volatile agent concentration and the corresponding anesthetic depth index during general anesthesia.

Supporting Evidence

  • 29.5% of cases had prolonged extubation.
  • 25% of cases with BIS <35 and MAC fraction >1.0 had ≥15 minutes of very low BIS.
  • The incidence of very low BIS and high MAC fraction significantly exceeded 10%.

Takeaway

The study found that many patients were given too much anesthesia without any benefit, suggesting doctors should check their anesthesia levels more carefully.

Methodology

Retrospective database cohort study analyzing 8,566 cases with BIS monitoring.

Potential Biases

Potential bias due to the retrospective nature of the study and reliance on electronic health records.

Limitations

The study was limited to a single department and may not generalize to other settings.

Participant Demographics

Patients included were primarily adults, with 3.1% aged <18 years.

Statistical Information

P-Value

<0.0001

Confidence Interval

95% CI: 24% to 26%

Statistical Significance

p<0.0001

Digital Object Identifier (DOI)

10.7759/cureus.75036

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