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.

backgroundPreviously, a depth of anesthesia bispectral index (BIS™) <45 was considered low

methodsThe retrospective database cohort study included N = 8,566 cases from September 13, 2016, to August 12, 2024 that met the following criteria: (1) ≥100 minutes of BIS monitoring (BIS minutes); (2) use of general anesthesia; (3) tracheal intubation and extubation performed in the operating room where the anesthetic was administered; and (4) absence of prone positioning. The latter three were characteristics of studies examining prolonged extubation, defined as ≥15 minutes from the end of surgery. From the

resultsAmong the 8,566 cases with ≥100 minutes of BIS monitor use, 29.5% (2,527) had prolonged extubation. There were contemporaneously 152,443 other cases without BIS monitoring. Those other cases had a nearly identical incidence of prolonged extubations (29.3%, 44,675). A total of 375 distinct anesthesia practitioners used the BIS monitor during the 8,566 cases, with each contributing, on average, only 0.27% (standard deviation [SD] = 0.33%) of anesthetic minutes. Among the

conclusionsIf 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.