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.
- 1Department of Anesthesiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania. [email protected].
- 2Department of Anesthesiology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
- 3Department of Orthopaedics and Traumatology, Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Abstract
Background
Postoperative 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.Methods
This 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).Results
Ninety-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).Conclusions
This study did not demonstrate superiority of BIS-controlled sedation compared to clinically guided sedation with regard to cognitive outcomes. Further studies are needed.Trial registration
ClinicalTrials.gov (NCT06241859, January 28, 2024).
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BibTeX
@article{jaremko2026effect,
title = {{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.}},
author = {Inna Jaremko and Gabrielė Milkintaitė and Arūnas Gelmanas and Alfredas Smailys and Tadas Lenkutis and Andrius Macas},
journal = {Journal of anesthesia, analgesia and critical care},
year = {2026},
month = jul,
doi = {10.1186/s44158-026-00437-0},
url = {https://europepmc.org/article/MED/42897692},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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.
AU - Inna Jaremko
AU - Gabrielė Milkintaitė
AU - Arūnas Gelmanas
AU - Alfredas Smailys
AU - Tadas Lenkutis
AU - Andrius Macas
PY - 2026
DA - 2026/07/01
JO - Journal of anesthesia, analgesia and critical care
DO - 10.1186/s44158-026-00437-0
UR - https://europepmc.org/article/MED/42897692
AB - Background Postoperative 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.Methods This 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).Results Ninety-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).Conclusions This study did not demonstrate superiority of BIS-controlled sedation compared to clinically guided sedation with regard to cognitive outcomes. Further studies are needed.Trial registration ClinicalTrials.gov (NCT06241859, January 28, 2024).
SN - 2731-3786
ER -