Oliveira Carlos Rogério Degrandi, Bernardo Wanderley Marques, Nunes Victor Moisés
Hospital Guilherme Alvaro, Departamento de Anestesiologia, Santos, SP, Brazil; Hospital Ana Costa, Departamento de Anestesiologia, Santos, SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Medicina Baseada em Evidência, São Paulo, SP, Brazil; Centro Universitário Lusíada, Faculdade de Medicina de Santos, Santos, SP, Brazil; Programa Diretrizes da Associação Médica Brasileira, Santos, SP, Brazil.
Braz J Anesthesiol. 2017 Jan-Feb;67(1):72-84. doi: 10.1016/j.bjane.2015.09.001. Epub 2016 Apr 14.
The bispectral index parameter is used to guide the titration of general anesthesia; however, many studies have shown conflicting results regarding the benefits of bispectral index monitoring. The objective of this systematic review with meta-analysis is to evaluate the clinical impact of monitoring with the bispectral index parameter.
The search for evidence in scientific information sources was conducted during December 2013 to January 2015, the following primary databases: Medline/PubMed, LILACS, Cochrane, CINAHL, Ovid, SCOPUS and TESES. The criteria for inclusion in the study were randomized controlled trials, comparing general anesthesia monitored, with bispectral index parameter with anesthesia guided solely by clinical parameters, and patients aged over 18 years. The criteria for exclusion were studies involving anesthesia or sedation for diagnostic procedures, and intraoperative wake-up test for surgery of the spine.
The use of monitoring with the bispectral index has shown benefits reducing time to extubation, orientation in time and place, and discharge from both the operating room and post anesthetic care unit. The risk of nausea and vomiting after surgery was reduced by 12% in patients monitored with bispectral index. Occurred a reduction of 3% in the risk of cognitive impairment postoperatively at 3 months postoperatively and 6% reduction in the risk of postoperative delirium in patients monitored with bispectral index. Furthermore, the risk of intraoperative memory has been reduced by 1%.
Clinically, anesthesia monitoring with the BIS can be justified because it allows advantages from reducing the recovery time after waking, mainly by reducing the administration of general anesthetics as well as the risk of adverse events.
脑电双频指数参数用于指导全身麻醉的滴定；然而，许多研究对于脑电双频指数监测的益处给出了相互矛盾的结果。本项带有荟萃分析的系统评价旨在评估脑电双频指数参数监测的临床影响。
于2013年12月至2015年1月期间在以下主要数据库中检索科学信息源中的证据：Medline/PubMed、拉丁美洲及加勒比地区卫生科学数据库、考克兰图书馆、护理学与健康领域数据库、Ovid、Scopus和学位论文数据库。纳入本研究的标准为随机对照试验，比较采用脑电双频指数参数监测的全身麻醉与仅由临床参数指导的麻醉，且患者年龄超过18岁。排除标准为涉及诊断性操作的麻醉或镇静研究，以及脊柱手术的术中唤醒试验。
使用脑电双频指数监测已显示出在缩短拔管时间、时间和地点定向以及从手术室和麻醉后护理单元出院时间方面的益处。采用脑电双频指数监测的患者术后恶心和呕吐风险降低了12%。在术后3个月时，采用脑电双频指数监测的患者术后认知障碍风险降低了3%，术后谵妄风险降低了6%。此外，术中记忆风险降低了1%。
在临床上，使用脑电双频指数进行麻醉监测是合理的，因为它具有缩短苏醒后恢复时间的优势，主要是通过减少全身麻醉药物的使用以及不良事件的风险。
