Evidence map›Paper›PMID 42897692›Full record

ArticleJournal of anesthesia, analgesia and critical care2026

The effect of bispectral index-controlled sedation on postoperative cognitive health in elderly patients with spinal anesthesia undergoing elective total knee arthroplasty: randomized, blinded study.

Inna Jaremko, Gabrielė Milkintaitė, Arūnas Gelmanas, Alfredas Smailys, Tadas Lenkutis, Andrius Macas

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In one paragraph

Article in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06241859 (The Influence of Sedation Depth Monitoring for Cognitive Functions and Early Rehabilitation After the Elective Total Knee Joints Replacement Surgery in Elderly Patients), which is not on this map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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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.

NCT06241859 naunknown statusnot on this map

The Influence of Sedation Depth Monitoring for Cognitive Functions and Early Rehabilitation After the Elective Total Knee Joints Replacement Surgery in Elderly Patients: Prospective, Randomized, Double-blind Study

TypeinterventionalSponsorLithuanian University of Health SciencesRan2024 to 2025Enrolled100ConditionsTotal Knee Replacement SurgeryArmsDräger Infinity Delta series monitor (Dräger, Germany) with Covidien BIS LoC 2 channel module and BIS Quatro (4 electrodes) sensor (Covidien, Ireland)
3 · Its place in the literature

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0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

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5 · Who and what money

Authors and funding

6 authors.

Inna JaremkoDepartment of Anesthesiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. inna.jaremko@lsmu.lt.
Gabrielė MilkintaitėDepartment of Anesthesiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Arūnas GelmanasDepartment of Anesthesiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Alfredas SmailysDepartment of Orthopaedics and Traumatology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Tadas LenkutisDepartment of Anesthesiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Andrius MacasDepartment of Anesthesiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostoperative cognitive dysfunction (POCD) commonly affects elderly patients, but the impact of BIS-guided sedation during elective orthopedic surgery under spinal anesthesia remains unclear. The aim was to compare BIS-controlled versus standard clinically guided sedation on POCD in elderly patients undergoing elective knee arthroplasty.

methodsThis was a prospective, patient- and outcome assessor-blinded, randomized controlled clinical study. Participants were randomized into two groups: BIS-targeted sedation (BIS group > 70) and standard clinical sedation (non-BIS group). All patients received the same anesthetic and analgesic. The primary outcome was the change in cognitive function over time. Cognitive function was assessed four times using the Addenbrooke's Cognitive Examination-Revised (ACE-R) questionnaire. Higher scores indicate better cognitive performance. The emotional status was evaluated two times using the Hospital Anxiety and Depression Scale (HADS).

resultsNinety-two patients (46 per group) were included in the final analysis. No statistically significant differences in total ACE-R score were found between the two groups at any time point (p > 0.05). Within the BIS group, total ACE-R scores were significantly higher on postoperative day (POD) 90 than preoperatively (PO) (87 (65-96) vs. 92 (70-98), p = 0.007). In the non-BIS group, total ACE-R scores increased significantly at several time points: from PO to 30 POD (87 (48-96) vs. 90.5 (40-98), p = 0.007), from PO to 90 POD (87 (48-96) vs. (91 (40-99), p < 0.001), and from 2 to 30 POD (88 (45-98) vs. 90.5 (40-98), p = 0.005). Significant decline in the number of patients experiencing probable anxiety at 30 POD compared with PO in both groups (BIS 28.3% to 2.2%, p = 0.004; non-BIS 32.6% to 8.7%, p = 0.015).

conclusionsThis study did not demonstrate superiority of BIS-controlled sedation compared to clinically guided sedation with regard to cognitive outcomes. Further studies are needed.

trial registrationClinicalTrials.gov (NCT06241859, January 28, 2024).

Indexed as

BIS-guided sedationCognitive functionElderlyElective knee arthroplastyPreoperative anxietySpinal anesthesia

Identifiers

PMID42897692
PMCPMC13682111

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