Evidence map›Paper›PMID 39754470›Full record

Trial reportPaediatric anaesthesia2025

BIS Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial.

T Wesley Templeton, Gijo Alex, Jean D Eloy, Lindsay Stollings, Richard J Ing, Eric C Cheon, Kumar Belani, Ilan Breskin, Peter S Sebel, Brad M Taicher and 1 more

Registry-linked trialAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Paediatric anaesthesia, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04810481 (Bispectral Index and End-Tidal Anesthetic Gas Concentration in Pediatric Patients Undergoing Sevoflurane Anesthesia), which is not on this map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04810481 nacompletednot on this map

Bispectral Index and End-Tidal Anesthetic Gas Concentration in Pediatric Patients Undergoing Sevoflurane Anesthesia (BTIGER)

TypeinterventionalSponsorMedtronic - MITGRan2021 to 2022Enrolled209ConditionsAnesthesiaArmsBIS Complete Monitoring System
3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Review
  6. Article
  7. Review
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

T Wesley TempletonDepartment of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.ORCID 0000-0002-7665-8138
Gijo AlexUT Southwestern Medical Center, Children's Health Dallas, Dallas, Texas, USA.
Jean D EloyDepartment of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Lindsay StollingsUniversity of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Richard J IngDepartment of Pediatric Anesthesiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
Eric C CheonDepartment of Pediatric Anesthesiology, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.ORCID 0000-0003-1471-359X
Kumar BelaniDepartment of Anesthesiology, M Health Fairview, Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota, USA.
Ilan BreskinResearch and Development, Acute Care & Monitoring, Medtronic, Jerusalem, Israel.
Peter S SebelDepartment of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Brad M TaicherDepartment of Anesthesiology, Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA.ORCID 0000-0001-9985-8637
BTiger Study Group

Funding

Medtronic
6 · The paper itself

Abstract

backgroundIn pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.

aimsThe primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4-18 years of age.

methodsParticipants in three age groups (4-8, 9-12, and 13-18 years) were randomized to either the BIS guided group or the control group. Use of sevoflurane as the primary maintenance anesthetic was the only requirement in both arms. In the BIS guided group, sevoflurane was titrated to achieve a target BIS value of 45-60 during the maintenance period. In the control arm, clinicians were blinded to the BIS value. Primary outcome was mean end-tidal sevoflurane concentration during maintenance phase of anesthesia. Secondary assessments included time to discharge and the readiness and quality of recovery as assessed by the Pediatric Anesthesia Emergence Delirium scale, the modified Aldrete Score, and the Wong-Baker FACES scale. An intention-to-treat analysis was used to analyze and compare groups.

resultsA total of 180 participants were randomized. Following randomization, 10 participants did not undergo any study procedures, leaving 84 participants in the BIS guided group and 86 participants in the control group. Across all age groups, the average end-tidal sevoflurane concentration was less in the BIS guided group compared to control (4-8 years: 2.2% ± 0.3% vs. 2.4% ± 0.4%, -0.3% [-0.4%, -0.1%]; 9-12 years: 1.7% ± 0.5% vs. 2.1% ± 0.6%, -0.4% [-0.7%, -0.1%]; 13-18 years: 1.6% ± 0.4% vs. 1.9% ± 0.5%, -0.3% [-0.5%, -0.1%]). No differences in recovery outcomes between treatment groups were observed.

conclusionsIn pediatric participants, the BIS guided group reported a lower average end-tidal sevoflurane concentration compared to control, though no significant differences in recovery profile were noted. CLINICAL IMPLICATIONS: The Bispectral Index (BIS) is a processed EEG tool that can be used to titrate general anesthesia to achieve desired anesthetic depth. Brain monitoring with BIS resulted in lower average end-tidal sevoflurane concentrations in children aged 4-18 years undergoing general anesthesia.

trial registrationClinicalTrials.gov identifier: NCT04810481.

Indexed as

Anesthetics, InhalationConsciousness MonitorsElective Surgical ProceduresElectroencephalographyMonitoring, IntraoperativeSevofluraneAdolescentAnesthesia Recovery PeriodChildChild, PreschoolFemaleHumansMaleAnesthetics, InhalationSevofluraneBispectral Indexbrain monitoringdepth of anesthesiainhaled anestheticsprocessed EEG

Identifiers

PMID39754470
PMCPMC11883502

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.