Consistency of the anesthesia consciousness index versus the bispectral index during laparoscopic gastrointestinal surgery with sevoflurane anesthesia: A prospective multi-center randomized controlled clinical study

Jian Zhan; Feng Chen; Zhuoxi Wu; Zhenxin Duan; Qiangting Deng; Jun Zeng; Lihong Hou; Jun Zhang; Yongyu Si; Kexuan Liu; Mingjun Wang; Hong Li

doi:10.3389/fnagi.2023.1084462

Consistency of the anesthesia consciousness index versus the bispectral index during laparoscopic gastrointestinal surgery with sevoflurane anesthesia: A prospective multi-center randomized controlled clinical study

Front Aging Neurosci. 2023 Mar 9:15:1084462. doi: 10.3389/fnagi.2023.1084462. eCollection 2023.

Authors

Jian Zhan^{1

2}, Feng Chen¹, Zhuoxi Wu¹, Zhenxin Duan¹, Qiangting Deng³, Jun Zeng⁴, Lihong Hou⁵, Jun Zhang⁶, Yongyu Si⁷, Kexuan Liu⁸, Mingjun Wang⁹, Hong Li¹

Affiliations

¹ Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China.
² Department of Anesthesiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
³ Editorial Office of Journal of Army Medical University, Army Medical University, Chongqing, China.
⁴ Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
⁵ Department of Anesthesiology, Xijing Hospital of Air Force Military Medical University, Xi'an, Shanxi, China.
⁶ Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China.
⁷ Department of Anesthesiology, Second Affiliated Hospital of Kunming Medical University, Kunming, China.
⁸ Department of Anesthesiology, Nanfang Hospital of Southern Medical University, Guangzhou, China.
⁹ Department of Anesthesiology, Chinese People's Liberation Army General Hospital, Beijing, China.

Abstract

Background: This study aimed to compare the consistency of anesthesia consciousness index (Ai) with that of bispectral index (BIS) in monitoring the depth of anesthesia (DOA) during sevoflurane anesthesia, to reveal the optimal cutoff values in different states of consciousness, and explore the stability of DOA monitoring during intraoperative injurious stimulation.

Methods: We enrolled 145 patients (97 men and 48 women) from 10 medical centers. General anesthesia was induced using intravenous anesthetics and maintained with sevoflurane. Ai and BIS values were recorded.

Results: The mean difference between the Ai and BIS was-0.1747 (95% confidence interval, -0.6660 to 0.3166; p = 0.4857). The regression equation of Ai and BIS from the Deming regression analysis was y = 5.6387 + 0.9067x (y is BIS, x is Ai), and the slope and intercept were statistically significant. Meanwhile, the receiver operating characteristic curve analysis of anesthesia-induced unconsciousness, loss of consciousness, and recovery of consciousness revealed that the accuracy of Ai and BIS were similar. In addition, the optimal cutoff values of the different states of consciousness were not sensitive to age, and both Ai and BIS had no correlation with hemodynamics.

Conclusion: We conclude that Ai and BIS show no systematic deviation in readings with high consistency, similar accuracy, and good stability; these insights provide more data for clinical application.

Keywords: anesthesia consciousness index; bispectral index; consistency; depth of anesthesia; sevoflurane.