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Randomized Controlled Trial
. 2014 Sep 18:14:79.
doi: 10.1186/1471-2253-14-79. eCollection 2014.

Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: secondary analysis of a randomized controlled trial

Jennifer L Vance  1 , Amy M Shanks  1 , Derek T Woodrum  1
Affiliations
Randomized Controlled Trial

Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: secondary analysis of a randomized controlled trial

Jennifer L Vance et al. BMC Anesthesiol. .

Abstract

Background: Fast track recovery is a care process goal after cardiac surgery. Intraoperative anesthetic depth may impact recovery, but the impact of brain monitoring on time to extubation and intensive care unit (ICU) length of stay after cardiac surgery has not been extensively studied. Our goal was to determine if BIS-guided anesthesia improves time to extubation compared to MAC-guided anesthesia in a cardiac surgery population.

Methods: In this secondary outcome analysis of a randomized controlled study, we analyzed 294 patients undergoing elective coronary bypass grafting, valve replacements, and bypass plus valve replacements at a single tertiary referral center between February 1, 2009 and April 30, 2010. We analyzed cardiac surgery patients that had been randomized to BIS-guided anesthesia alerts (n = 131) or MAC-guided anesthesia alerts (n = 163). The primary outcome measure was time to extubation in the BIS-guided and anesthetic concentration-guided groups. Secondary outcomes were length of stay in the ICU and total postoperative hospital length of stay.

Results: Valid extubation time data were available for 247 of 294 patients. The median [IQR] time to extubation was 307 [215 to 771] minutes in the BIS group and 323 [196 to 730] minutes in the anesthetic concentration group (p = 0.61). The median [IQR] ICU length of stay was 54 [29 to 97] hours versus 70 [44 to 99] hours (p = 0.11). In terms of postoperative hospital length of stay, there was no difference between the groups with median [IQR] times of 6 [5-8] days (p = 0.69) in each group.

Conclusions: The use of intraoperative BIS monitoring during cardiac surgery did not change time to extubation, ICU length of stay or hospital length of stay. Data regarding BIS monitoring and recovery in an exclusively cardiac surgery population are consistent with recent effectiveness studies in the general surgical population.

Trial registration: ClinicalTrials.gov number NCT00689091.

Keywords: BIS; Cardiac surgery; Fast-track extubation.

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References

    1. London MJ, Shroyer AL, Coll JR, MaWhinney S, Fullerton DA, Hammermeister KE, Grover FL. Early extubation following cardiac surgery in a veterans population. Anesthesiol. 1998;88:1447–1458. doi: 10.1097/00000542-199806000-00006. - DOI - PubMed
    1. Cheng DC, Karski J, Peniston C, Raveendran G, Asokumar B, Carroll J, David T, Sandler A. Early tracheal extubation after coronary artery bypass graft surgery reduces costs and improves resource use. A prospective, randomized, controlled trial. Anesthesiol. 1996;85:1300–1310. doi: 10.1097/00000542-199612000-00011. - DOI - PubMed
    1. Wong DT, Cheng DC, Kustra R, Tibshirani R, Karski J, Carroll-Munro J, Sandler A. Risk factors of delayed extubation, prolonged length of stay in the intensive care unit, and mortality in patients undergoing coronary artery bypass graft with fast-track cardiac anesthesia: a new cardiac risk score. Anesthesiol. 1999;91:936–944. doi: 10.1097/00000542-199910000-00012. - DOI - PubMed
    1. Ender J, Borger MA, Scholz M, Funkat AK, Anwar N, Sommer M, Mohr FW, Fassl J. Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept. Anesthesiol. 2008;109:61–66. doi: 10.1097/ALN.0b013e31817881b3. - DOI - PubMed
    1. Chong JL, Grebenik C, Sinclair M, Fisher A, Pillai R, Westaby S. The effect of a cardiac surgical recovery area on the timing of extubation. J Cardiothorac Vasc Anesth. 1993;7:137–141. doi: 10.1016/1053-0770(93)90205-Y. - DOI - PubMed

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