Work

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

Year: 2024

Type: article

Abstract: BACKGROUND: and found to have no clinical benefit. A BIS <35 was considered very low and was not only without evident clinical benefit but also associated with a greater risk of postoperative delirium. We considered the association between BIS and the anesthetic dose of inhalational agents, quantified using the minimum alveolar concentration (MAC) fraction, which was the patient's end-tidal inhalational agent concentration divided by the agent's altitude- and age-adjusted minimum alveolar percentage concentration. The MAC fraction was displayed on the anesthesia machine. When the MAC fraction >1.0 and the BIS <35, it implies that the inhalational anesthetic agent concentration can be reduced without harmful clinical effects. We hypothesized a substantive percentage of cases (>10%) have long (≥15 minutes) periods having the combination of MAC fraction >1.0 and BIS <35. METHODS: = 8,566 cases studied, 1,862,022 BIS minutes were automatically recorded in the electronic health record. Comparisons were made with the matching MAC fractions. A Clopper-Pearson two-sided exact 95% confidence interval was calculated for the planned primary endpoint, the percentage of cases with ≥15 minutes wherein simultaneously the BIS <35 and MAC fraction >1.0. Post hoc, we added a 97.5% confidence interval for the incidence with ≥30 minutes to compare with 10%. RESULTS: < 0.0001). CONCLUSIONS: If department practices are such that processed electroencephalographic monitoring (e.g., BIS) is commonly used during general anesthesia to assess anesthetic depth, our results recommend auditing the volatile agent concentration and the corresponding anesthetic depth index, as we did in this study. We recommend that feedback and education regarding suitable titration of anesthetic agent concentrations relative to the index should be provided at the departmental level.

Source: Cureus

DOI: 10.7759/cureus.75036

Authors: Franklin Dexter, Richard H Epstein, Anil A Marian

Institutions: University of Iowa, University of Miami

Language: English

Topic: Anesthesia and Sedative Agents

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W4404960367