Authors' objectives: The objective of this report is to assess the clinical effectiveness and cost-effectiveness of BIS, E-Entropy and Narcotrend technologies to monitor the depth of anaesthesia in surgical patients undergoing GA.

Authors' recommendations: In general, BIS, E-Entropy and Narcotrend technologies for monitoring the depth of anaesthesia are associated with reductions in general anaesthetic consumption, and decreased anaesthetic recovery times, compared with monitoring of clinical signs alone. However, these reductions may be considered clinically modest. The available evidence on the impact of the technologies on reducing the likelihood of intraoperative awareness is limited. Overall, BIS was associated with a statistically significant reduction in intraoperative awareness in patients classified as at higher risk, although there is uncertainty in effect estimates because of significant heterogeneity. Caution is advised because of uncertainties about the risk of bias of many of the included trials, and because many outcome measures were not statistically powered.The cost-effectiveness of depth of anaesthesia monitoring appears to be highly dependent on the incidence of awareness, the HRQoL impact of psychological sequelae of awareness and the probability of developing psychological illness following awareness, as well as the effectiveness of depth of anaesthesia monitoring in reducing awareness. Cost-savings resulting from reduced use of anaesthetic drugs may offset some of the additional cost of depth of anaesthesia monitoring. The cost of sensors attached to the patient appears to be a key factor in the additional cost of depth of anaesthesia monitoring.This report makes the following research recommendations (in priority order): 1. RCTs of E-Entropy- and Narcotrend-guided anaesthesia monitoring are needed, in high-risk patients, with adequate statistical power to detect explicit intraoperative awareness, and of sufficient length of follow-up to detect delayed cases of awareness. 2. RCTs of all three technologies should also evaluate the effects of anaesthesia overdosing, including short-term effects, such as nausea and vomiting, as well as longer-term impact on cognitive function. 3. RCTs of E-Entropy- and Narcotrend-guided anaesthesia monitoring are also needed in children.

Project Status: Completed

Year Published: 2013

URL for published report: http://www.hta.ac.uk/2802

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

Copyright: 2013 Queen's Printer and Controller of HMSO