# Time Required for Extubation While Using Bispectral Index Monitoring Compared to End-Tidal Anesthetic Gas Concentration in Patients Undergoing General Anesthesia

## TL;DR

This study found that using BIS monitoring leads to faster extubation and lower anesthetic use compared to traditional gas concentration monitoring during general anesthesia.

## Contribution

The study demonstrates that BIS monitoring improves recovery efficiency and reduces anesthetic consumption compared to ETAG monitoring.

## Key findings

- BIS group had significantly shorter extubation time (148.4 seconds) compared to ETAG group (201.2 seconds).
- BIS-guided anesthesia reduced isoflurane consumption by an average of 0.66 mL per hour compared to ETAG.

## Abstract

Objective: The objective of this study was to compare extubation timings between patients monitored with the bispectral index (BIS) and those monitored using end-tidal anesthetic gas (ETAG) to determine which method provides a more efficient recovery profile.

Methodology: A prospective observational study was conducted on 50 patients aged 18 to 60 years, classified as American Society of Anesthesiologists (ASA) physical status I-II, undergoing elective surgeries under general anesthesia (GA). Patients were randomized into BIS and non-BIS (ETAG) groups to assess anesthetic consumption and recovery characteristics. Standard anesthetic protocols were followed. In the BIS group, BIS values were maintained between 40 and 60, while in the ETAG group, end-tidal isoflurane concentrations were kept between 0.7 and 1.3 minimum alveolar concentration (MAC). Intraoperative parameters and extubation times were recorded. Isoflurane administration was discontinued at the time of skin closure, and neuromuscular blockade was reversed once a train-of-four (TOF) ratio greater than 0.9 was confirmed. Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY), with a p-value less than 0.05 considered statistically significant.

Results: There was no statistically significant difference in the overall duration of anesthesia between the two groups (p > 0.05). However, the BIS group had a significantly shorter extubation time, averaging 148.4 ± 30.5 seconds, compared to 201.2 ± 43.6 seconds in the ETAG group. The mean difference was 52.8 ± 13.1 seconds (p = 0.001). Additionally, the average hourly isoflurane consumption was significantly lower in the BIS group (5.9 ± 0.77 mL) compared to the ETAG group (6.56 ± 1.12 mL), with a mean difference of 0.66 ± 1.04 mL (p = 0.01).

Conclusion: Extubation occurred significantly earlier in patients monitored with BIS than in those observed with ETAG. Furthermore, BIS-guided anesthesia was associated with reduced isoflurane consumption compared to ETAG-guided monitoring.