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Review
. 2016 Oct 18;10(10):CD007272.
doi: 10.1002/14651858.CD007272.pub2.

Anaesthetic interventions for prevention of awareness during surgery

Anthony G Messina  1 , Michael Wang, Marshall J Ward, Chase C Wilker, Brett B Smith, Daniel P Vezina, Nathan Leon Pace
Affiliations
Review

Anaesthetic interventions for prevention of awareness during surgery

Anthony G Messina et al. Cochrane Database Syst Rev. .

Abstract

Background: General anaesthesia is usually associated with unconsciousness. 'Awareness' is when patients have postoperative recall of events or experiences during surgery. 'Wakefulness' is when patients become conscious during surgery, but have no postoperative recollection of the period of consciousness.

Objectives: To evaluate the efficacy of two types of anaesthetic interventions in reducing clinically significant awareness:- anaesthetic drug regimens; and- intraoperative anaesthetic depth monitors.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, ISSUE 4 2016); PubMed from 1950 to April 2016; MEDLINE from 1950 to April 2016; and Embase from 1980 to April 2016. We contacted experts to identify additional studies. We performed a handsearch of the citations in the review. We did not search trial registries.

Selection criteria: We included randomized controlled trials (RCTs) of either anaesthetic regimens or anaesthetic depth monitors. We excluded volunteer studies, studies of patients prior to skin incision, intensive care unit studies, and studies that only randomized different word presentations for memory tests (not anaesthetic interventions).Anaesthetic drug regimens included studies of induction or maintenance, or both. Anaesthetic depth monitors included the Bispectral Index monitor, M-Entropy, Narcotrend monitor, cerebral function monitor, cerebral state monitor, patient state index, and lower oesophageal contractility monitor. The use of anaesthetic depth monitors allows the titration of anaesthetic drugs to maintain unconsciousness.

Data collection and analysis: At least two authors independently scanned abstracts, extracted data from the studies, and evaluated studies for risk of bias. We made attempts to contact all authors for additional clarification. We performed meta-analysis statistics in packages of the R language.

Main results: We included 160 studies with 54,109 enrolled participants; 53,713 participants started the studies and 50,034 completed the studies or data analysis (or both). We could not use 115 RCTs in meta-analytic comparisons because they had zero awareness events. We did not merge 27 of the remaining 45 studies because they had excessive clinical and methodological heterogeneity. We pooled the remaining 18 eligible RCTs in meta-analysis. There are 10 studies awaiting classification which we will process when we update the review.The meta-analyses included 18 trials with 36,034 participants. In the analysis of anaesthetic depth monitoring (either Bispectral Index or M-entropy) versus standard clinical and electronic monitoring, there were nine trials with 34,744 participants. The overall event rate was 0.5%. The effect favoured neither anaesthetic depth monitoring nor standard clinical and electronic monitoring, with little precision in the odds ratio (OR) estimate (OR 0.98, 95% confidence interval (CI) 0.59 to 1.62).In a five-study subset of Bispectral Index monitoring versus standard clinical and electronic monitoring, with 34,181 participants, 503 participants gave awareness reports to a blinded, expert panel who adjudicated or judged the outcome for each patient after reviewing the questionnaires: no awareness, possible awareness, or definite awareness. Experts judged 351 patient awareness reports to have no awareness, 87 to have possible awareness, and 65 to have definite awareness. The effect size favoured neither Bispectral Index monitoring nor standard clinical and electronic monitoring, with little precision in the OR estimate for the combination of definite and possible awareness (OR 0.96, 95% CI 0.35 to 2.65). The effect size favoured Bispectral Index monitoring for definite awareness, but with little precision in the OR estimate (OR 0.60, 95% CI 0.13 to 2.75).We performed three smaller meta-analyses of anaesthetic drugs. There were nine studies with 1290 participants. Wakefulness was reduced by ketamine and etomidate compared to thiopental. Wakefulness was more frequent than awareness. Benzodiazepines reduces awareness compared to thiopental, ketamine, and placebo., Also, higher doses of inhaled anaesthetics versus lower doses reduced the risk of awareness.We graded the quality of the evidence as low or very low in the 'Summary of findings' tables for the five comparisons.Most of the secondary outcomes in this review were not reported in the included RCTs.

Authors' conclusions: Anaesthetic depth monitors may have similar effects to standard clinical and electrical monitoring on the risk of awareness during surgery. In older studies comparing anaesthetics in a smaller portion of the patient sample, wakefulness occurred more frequently than awareness. Use of etomidate and ketamine lowered the risk of wakefulness compared to thiopental. Benzodiazepines compared to thiopental and ketamine, or higher doses of inhaled anaesthetics versus lower doses, reduced the risk of awareness.

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Conflict of interest statement

Anthony G Messina: none known.

Michael Wang was involved in the design, conduct, or publication of potentially eligible studies for this Cochrane review (Russell 1997; Russell 2001). Prof Wang has received funding from Abbvie for invited lectures and meeting attendance, including accidental anaesthetic awareness events. He has in the past been loaned two Bispectral Index monitors for research purposes by Aspect Medical/Covidian.

Marshall J Ward: none known.

Chase C Wilker: none known.

Brett B Smith: none known.

Daniel P Vezina: board member and executive position since January 2012 with a Big Data analytics private company (MedAnalytics), and a congestive heart failure clinical solution private company since June 2008 (Guardsman Scientific).

Nathan Leon Pace: none known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgments about each risk of bias item for each included study.
4
4
Meta‐analysis patient awareness reports not adjudicated or adjudicated as possible and definite awareness: ADM versus standard clinical and electronic monitoring
5
5
Meta‐analysis possible and definite awareness: ADM versus standard clinical and electronic monitoring (adjudication)
6
6
Meta‐analysis definite awareness: ADM versus standard clinical and electronic monitoring (adjudication)
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  • doi: 10.1002/14651858.CD007272

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    1. Jiahai M, Xueyan W, Yonggang X, Jianhong Y, Qunhui H, Zhi L, et al. Spectral entropy monitoring reduces anesthetic dosage for patients undergoing off‐pump coronary artery bypass graft surgery. Journal of Cardiothoracic and Vascular Anesthesia 2012;26(5):818‐21. [PUBMED: 22502772] - PubMed
Kamal 1990 {published data only}
    1. Kamal RS, Khan FA, Khan FH. Total intravenous anaesthesia with propofol and buprenorphine. Anaesthesia 1990;45(10):865‐70. [PUBMED: 2240504] - PubMed
Kasmacher 1996 {published data only}
    1. Käsmacher H, Petermeyer M, Decker C. Incidence and quality of dreaming during anesthesia with propofol in comparison with enflurane. Der Anaesthesist 1996;45:146‐53. [PUBMED: 8720887] - PubMed
Kerssens 2005b {published data only}
    1. Kerssens C, Ouchi T, Sebel PS. No evidence of memory function during anesthesia with propofol or isoflurane with close control of hypnotic state. Anesthesiology 2005;103:11‐9. [PUBMED: 15618787] - PubMed
Kerssens 2009 {published data only}
    1. Kerssens C, Gaither JR, Sebel PS. Preserved memory function during bispectral index‐guided anesthesia with sevoflurane for major orthopedic surgery. Anesthesiology 2009;111(3):518‐24. [PUBMED: 19672180] - PubMed
Kim 2007 {published data only}
    1. Kim JH, Lee YS, Kim WY, Kim HJ, Chang MS, Park JY, et al. Effect of nicardipine on haemodynamic and bispectral index changes following endotracheal intubation. Journal of International Medical Research 2007;35:52‐8. [PUBMED: 17408055] - PubMed
Kiyama 1997 {published data only}
    1. Kiyama S, Takeda J. Effect of extradural analgesia on the paradoxical arousal response of the electroencephalogram. British Journal of Anaesthesia 1997;79(6):750‐3. - PubMed
Kreuer 2003 {published data only}
    1. Kreuer S, Biedler A, Larsen R, Altmann S, Wilhelm W. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol‐remifentanil anesthesia. Anesthesiology 2003;99(1):34‐41. [PUBMED: 12826839] - PubMed
Kreuer 2005 {published data only}
    1. Kreuer S, Bruhn J, Stracke C, Aniset L, Silomon M, Larsen R, et al. Narcotrend or bispectral index monitoring during desflurane‐remifentanil anesthesia: a comparison with a standard practice protocol. Anesthesia and Analgesia 2005;101(2):427‐34, table of contents. [PUBMED: 16037157] - PubMed
Krissel 1994 {published data only}
    1. Krissel J, Dick WF, Leyser KH, Gervais H, Brockerhoff P, Schranz D. Thiopentone, thiopentone/ketamine, and ketamine for induction of anaesthesia in caesarean section. European Journal of Anaesthesiology 1994;11:115‐22. [PUBMED: 8174531 ] - PubMed
Kudoh 1999 {published data only}
    1. Kudoh A, Matsuki A. Middle latency auditory evoked potentials during total intravenous anesthesia with droperidol, ketamine and fentanyl. Clinical Electroencephalography 1999;30(2):79‐83. [PUBMED: 10358788] - PubMed
Kwon 2013 {published data only}
    1. Kwon MA, Song J, Kim J R. Tracheal intubation with rocuronium using a "modified timing principle". Korean Journal of Anesthesiology 2013; Vol. 64, issue 3:218‐22. [PUBMED: 23560186] - PMC - PubMed
Lallemand 2003 {published data only}
    1. Lallemand MA, Lentschener C, Mazoit JX, Bonnichon P, Manceau I, Ozier Y. Bispectral index changes following etomidate induction of general anaesthesia and orotracheal intubation. British Journal of Anaesthesia 2003;91(3):341‐6. [PUBMED: 12925471] - PubMed
Lam 2013 {published data only}
    1. Lam F, Liao CC, Lee YJ, Wang W, Kuo CJ, Lin CS. Different dosing regimens for propofol induction in obese patients. Anaesthesia 2013; Vol. 51, issue 2:53‐7. - PubMed
Lehmann 1985 {published data only}
    1. Lehmann KA, Horrichs G, Hoeckle W. The significance of tramadol as an intraoperative analgesic. A randomized double‐blind study in comparison with placebo. Der Anaesthesist 1985;34(1):11‐9. [PUBMED: 3883843] - PubMed
Lehmann 1992 {published data only}
    1. Lehmann KA, Krauskopf KH. Intraoperative awareness in balanced anesthesia. A literature review based on a randomized double blind study using fentanyl, pentazocine and ketamine. Der Anaesthesist 1992;41:373‐85. [PUBMED: 1497125] - PubMed
Lehmann 2007 {published data only}
    1. Lehmann A, Schmidt M, Zeitler C, Kiessling AH, Isgro F, Boldt J. Bispectral index and electroencephalographic entropy in patients undergoing aortocoronary bypass grafting. European Journal of Anaesthesiology 2007;27:751‐60. [PUBMED: 17241504] - PubMed
Lim 1992 {published data only}
    1. Lim BL, Low TC. Total intravenous anaesthesia versus inhalational anaesthesia for dental day surgery. Anaesthesia and Intensive Care 1992;20:475‐78. [PUBMED: 1463176] - PubMed
Lin 2011 {published data only}
    1. Lin CF, Yang CY, Chao E, Lee MS, See LC. Short‐term inhalation of sevoflurane during induction of general anesthesia can inhibit the A‐line ARX index response to intubation: a randomized trial. Chang Gung Medical Journal 2011;34(6):599‐606. [PUBMED: 2219606] - PubMed
Lindholm 2008 {published data only}
    1. Lindholm ML, Brudin L, Sandin RH. Bispectral index monitoring: appreciated but does not effect drug dosing and hypnotic levels. Acta Anaesthesiologica Scandinavica 2008;52:88‐94. [PUBMED: 17976226] - PubMed
Liu 2013 {published data only}
    1. Liu N, Pruszkowski O, Leroy J E, Chazot T, Trillat B, Colchen A, et al. Automatic administration of propofol and remifentanil guided by the bispectral index during rigid bronchoscopic procedures: a randomized trial. Canadian Journal of Anesthesia 2013;60(9):881‐7. [PUBMED: 23857041] - PubMed
Lu 2005 {published data only}
    1. Lu CH, Borel CO, Wu CT, Yeh CC, Jao SW, Chao PC, et al. Combined general‐epidural anesthesia decreases the desflurane requirement for equivalent A‐line ARX index in colorectal surgery. Acta Anaesthesiologica Scandinavica 2005;49:1063‐7. [PUBMED: 16095444] - PubMed
Maattanen 2002 {published data only}
    1. Maattanen H, Anderson R, Uusijarvi J, Jakobsson J. Auditory evoked potential monitoring with the AAITM‐index during spinal surgery: decreased desflurane consumption. Acta Anaesthesiologica Scandinavica 2002;46(7):882‐6. [PUBMED: 12139546] - PubMed
Mashour 2012 {published and unpublished data}
    1. Mashour GA, Shanks A, Tremper KK, Kheterpal S, Turner CR, Ramachandran SK, et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. Anesthesiology 2012;117(4):717‐25. [Pubmed: 22990178] - PMC - PubMed
Masuda 2002 {published data only}
    1. Masuda T, Yamada H, Takada K, Sagata Y, Yamaguchi M, Tomiyama Y, et al. Bispectral index monitoring is useful to reduce total amount of propofol and to obtain immediate recovery after propofol anesthesia. Masui 2002;51(4):394‐9. [PUBMED: 11995347] - PubMed
McNulty 1995 {published data only}
    1. McNulty SE, Gratch D, Costello D, Heropoulos M, Kim JY. The effect of midazolam and lorazepam on postoperative recovery after cardiac surgery. Anesthesia and Analgesia 1995;81(2):404‐7. [PUBMED: 7618736] - PubMed
Menigaux 2002 {published data only}
    1. Menigaux C, Guignard B, Adam F, Sessler DI, Joly V, Chauvin M. Esmolol prevents movement and attenuates the BIS response to orotracheal intubation. British Journal of Anaesthesia 2002;89(6):857‐62. [PUBMED: 12453930] - PubMed
Mertens 2003 {published data only}
    1. Mertens MJ, Olofsen E, Engbers FH, Burm AG, Bovill JG, Vuyk J. Propofol reduces perioperative remifentanil requirements in a synergistic manner: response surface modeling of perioperative remifentanil‐propofol interactions. Anesthesiology 2003;99(2):347‐59. [PUBMED: 12883407] - PubMed
Miller 1996 {published data only}
    1. Miller DR, Blew PG, Martineau RJ, Hull KA. Midazolam and awareness with recall during total intravenous anaesthesia. Canadian Journal of Anaesthesia 1996;43(9):946‐53. [PUBMED: 8874913] - PubMed
Miranda 1992 {published data only}
    1. Miranda AF, Kyi W, Sivalingam N. Propofol and methohexitone for elective caesarean‐‐a comparative study. Medical Journal of Malaysia 1992;47(4):280‐6. [PUBMED: 1303480 ] - PubMed
Monedero 1994 {published data only}
    1. Monedero P, Carrascosa F, Garcia‐Pedrajas F, Panadero A, Hidalgo F, Arroyo JL. Does propofol have advantages over midazolam and isoflurane? Comparative study of 2 total intravenous anesthesia techniques using midazolam and propofol, versus balanced anesthesia with isoflurane. Revista Espanola de Anestesiologia y Reanimacion 1994;41(3):156‐64. [PUBMED: 8059043 ] - PubMed
Morimoto 2002 {published data only}
    1. Morimoto Y, Oka S, Mii M, Shinjo Y, Yamashita A, Gohara T, et al. Efficacy of bispectral index monitoring in improving anesthetic management, economics, and use of the operating theater. Masui 2002;51(8):862‐8. [PUBMED: 12229134] - PubMed
Mozafari 2014 {published data only}
    1. Mozafari H, Fakhr AA, Salehi I, Moghimbigi A. The ability of bispectral‐guided management compared to routine monitoring for reflecting awareness rate in patients undergoing abdominal surgery. Iranian Red Crescent Medical Journal 2014;16(9):e13584. - PMC - PubMed
Muralidhar 2008 {published data only}
    1. Muralidhar K, Banakal S, Murthy K, Garg R, Rani GR, Dinesh R. Bispectral index‐guided anaesthesia for off‐pump coronary artery bypass grafting. Annals of Cardiac Anesthesia 2008;11(2):105‐10. [PUBMED: 18603750 ] - PubMed
Myles 1997 {published data only}
    1. Myles PS, Buckland MR, Weeks AM, Bujor MA, McRae R, Langley M, et al. Hemodynamic effects, myocardial ischemia, and timing of tracheal extubation with propofol‐based anesthesia for cardiac surgery. Anesthesia and Analgesia 1997;84(1):12‐9. [PUBMED: 8988992] - PubMed
Myles 2004 {published and unpublished data}
    1. Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B‐Aware randomised controlled trial. Lancet 2004;363:1757‐63. [PUBMED: 15172773 ] - PubMed
Myles 2007 {published data only}
    1. Myles PS, Leslie K, Chan MT, Forbes A, Paech MJ, Peyton P, et al. Avoidance of nitrous oxide for patients undergoing major surgery: a randomized controlled trial. Anesthesiology 2007;107(2):221‐31. [PUBMED: 17667565] - PubMed
Navarro 2000 {published data only}
    1. Navarro EM. Desflurane‐‐general anesthesia for cesarean section compared with isoflurane and epidural anesthesia. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie 2000;35(4):232‐6. [PUBMED: 10830075] - PubMed
Nayar 2009 {published data only}
    1. Nayar R, Sahajanand H. Does anesthetic induction for Cesarean section with a combination of ketamine and thiopentone confer any benefits over thiopentone or ketamine alone? A prospective randomized study. Minerva Anestesiologica 2009;75(4):185‐90. [PUBMED: 18946429] - PubMed
Ngan 1997 {published data only}
    1. Ngan Kee WD, Khaw KS, Ma ML, Mainland PA, Gin T. Postoperative analgesic requirement after cesarean section: a comparison of anesthetic induction with ketamine or thiopental. Anesthesia and Analgesia 1997;85(6):1294‐8. - PubMed
Ngan Kee 2002 {published data only}
    1. Ngan Kee WD, Khaw KS, Ma KC, Wong AS, Lee BB. Randomized, double‐blind comparison of different inspired oxygen fractions during general anaesthesia for Caesarean section. British Journal of Anaesthesia 2002;89(4):556‐61. [PUBMED: 12393355] - PubMed
Oddby‐Muhrbeck 1993 {published data only}
    1. Oddby‐Muhrbeck E, Jakobsson J. Recall of music: a comparison between anaesthesia with propofol and isoflurane. Acta Anaesthesiologica Scandinavica 1993;37:33‐7. [PUBMED: 8424291] - PubMed
Panousis 2009 {published data only}
    1. Panousis P, Heller AR, Koch T, Litz RJ. Epidural ropivacaine concentrations for intraoperative analgesia during major upper abdominal surgery: a prospective, randomized, double‐blinded, placebo‐controlled study. Anesthesia and Analgesia 2009;108(6):1971‐6. [PUBMED: 19448234] - PubMed
Pauls 2009 {published data only}
    1. Pauls RJ, Dickson TJ, Kaufmann AM, Cappellani RB, Ringaert KR, West M, et al. A comparison of the ability of the EEGo and BIS monitors to assess emergence following neurosurgery. Canadian Journal of Anaesthesia 2009;56(5):366‐73. [PUBMED: 19340492] - PubMed
Paventi 2001 {published data only}
    1. Paventi S, Santevecchi A, Metta E, Annetta MG, Perilli V, Sollazzi L, et al. Bispectral index monitoring in sevoflurane and remifentanil anesthesia. Analysis of drugs management and immediate recovery. Minerva Anestesiologica 2001;67(6):435‐9. [PUBMED: 11533541] - PubMed
Pedersen 1992 {published data only}
    1. Pedersen JE, Fernandes A, Christensen M. Halothane 2% for caesarean section. European Journal of Anaesthesiology 1992;9:319‐24. [PUBMED: 1628635] - PubMed
Persec 2012 {published data only}
    1. Persec J, Persec Z, Kopljar M, Sojcic N, Husedzinovic I. Effect of bispectral index monitoring on extubation time and analgesic consumption in abdominal surgery: a randomised clinical trial. Swiss Medical Weekly 2012; Vol. 142:w13689. [PUBMED: 23135976] - PubMed
Piggott 1990 {published data only}
    1. Piggott SE, Bogod DG, Rosen M, Rees GA, Harmer M. Isoflurane with either 100% oxygen or 50% nitrous oxide in oxygen for caesarean section. British Journal of Anaesthesia 1990;65:325‐9. [PUBMED: 2121203] - PubMed
Plourde 1996 {published data only}
    1. Plourde G, Villemure C. Comparison of the effects of enflurane/N2O on the 40‐Hz auditory steady‐state response versus the auditory middle‐latency response. Anesthesia and Analgesia 1996;82:75‐83. [PUBMED: 8712429] - PubMed
Puri 2003 {published data only}
    1. Puri GD, Murthy SS. Bispectral index monitoring in patients undergoing cardiac surgery under cardiopulmonary bypass. European Journal of Anaesthesiology 2003;20:451‐6. [PUBMED: 12803261] - PubMed
Puri 2007 {published data only}
    1. Puri GD, Kumar B, Aveek J. Closed‐loop anaesthesia delivery system (CLADS) using bispectral index: a performance assessment study. Anaesthesia and Intensive Care 2007;35(3):357‐62. [PUBMED: 17591128] - PubMed
Rehberg 2007 {published data only}
    1. Rehberg B, Ryll C, Hadzidiakos D, Baars J. Use of a target‐controlled infusion system for propofol does not improve subjective assessment of anaesthetic depth by inexperienced anaesthesiologists. European Journal of Anaesthesiology 2007;24:920‐6. [PUBMED: 17588273 ] - PubMed
Renna 2000 {published data only}
    1. Renna M, Lang EM, Lockwood GG. The effect of sevoflurane on implicit memory: a double‐blind, randomised study. Anaesthesia 2000;55(7):634‐40. [PUBMED: 10919417] - PubMed
Rinaldi 2005 {published data only}
    1. Rinaldi S, Consales G, Gallerani E, Ortolani O, Gaudio AR. A‐line autoregression index monitoring to titrate inhalational anaesthesia: effects on sevoflurane consumption, emergence time and memory. Acta Anaesthesiologica Scandinavica 2007;49:692‐7. [PUBMED: 15836686] - PubMed
Russell 1986 {published data only}
    1. Russell IF. Comparison of wakefulness with two anaesthetic regimens. Total i.v. v. balanced anaesthesia. British Journal of Anaesthesia 1986;58(9):965‐8. [PUBMED: 3756056] - PubMed
Samarkandi 2004 {published data only}
    1. Samarkandi AH, Abdel Meguid ME, Abdullah KM, Riad W. Bispectral index monitoring and titration of anaesthetics during off‐pump coronary artery bypass surgery. Egyptian Journal of Anaesthesia 2004;20:357‐61.
Sareen 1997 {published data only}
    1. Sareen J, Hudson RJ, Rosenbloom M, Thomson IR. Dose‐response to anaesthetic induction with sufentanil: haemodynamic and electroencephalographic effects. Canadian Journal of Anaesthesia 1997;44(1):19‐25. [PUBMED: 8988819] - PubMed
Schultetus 1986 {published data only}
    1. Schultetus RR, Hill CR, Dharamraj CM, Banner TE, Berman LS. Wakefulness during cesarean section after anesthetic induction with ketamine, thiopental, or ketamine and thiopental combined. Anesthesia and Analgesia 1986;65:723‐8. [PUBMED: 3717612 ] - PubMed
Schwender 1994 {published data only}
    1. Schwender D, Kaiser A, Klasing S, Peter K, Pöppel E. Midlatency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology 1994;80:493‐501. [PUBMED: 8141445] - PubMed
Schwender 1996 {published data only}
    1. Schwender D, Daunderer M, Mulzer S, Klasing S, Finsterer U, Peter K. Spectral edge frequency of the electroencephalogram to monitor "depth" of anaesthesia with isoflurane or propofol. British Journal of Anaesthesia 1996;77:179‐84. [PUBMED: 8881621] - PubMed
Shin 2012 {published data only}
    1. Shin MK, Shim HS, Yang GY, Sung WS. Effect of a target‐controlled infusion of remifentanil in combination with desflurane during the "maintenance" phase of general anesthesia. Korean Journal of Anesthesiology 2012;63(1):25‐9. [PUBMED: 22870361] - PMC - PubMed
Sidi 1990 {published data only}
    1. Sidi A, Halimi P, Cotev S. Estimating anesthetic depth by electroencephalography during anesthetic induction and intubation in patients undergoing cardiac surgery. Journal of Clinical Anesthesia 1990;2(2):101‐7. - PubMed
Smith 1999 {published data only}
    1. Smith TL, Zapala D, Thompson CL, Hoye W, Kelly T. Relationship of auditory middle latency response and stem‐word completion test as indicators of implicit memory formation during general anesthesia. Journal of the American Association of Nurse Anesthetists 1999;67(3):247‐53. [PUBMED: 10488296] - PubMed
Song 1997 {published data only}
    1. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anaesthesiology 1997;87(4):842‐8. [PUBMED: 9357886] - PubMed
Sorbara 1995 {published data only}
    1. Sorbara C, Pittarello D, Rizzoli G, Pasini L, Armellin G, Bonato R, et al. Propofol‐fentanyl versus isoflurane‐fentanyl anesthesia for coronary artery bypass grafting: effect on myocardial contractility and peripheral hemodynamics. Journal of Cardiothoracic and Vascular Anesthesia 1995;9(1):18‐23. [PUBMED: 7718750] - PubMed
Soyannwo 1988 {published data only}
    1. Soyannwo OA, Elegbe EO, Odugbesan CO. Effect of flunitrazepam (Rohypnol) on awareness during anaesthesia for caesarean section. African Journal of Medicine and Medical Sciences 1988;17(1):23‐6. [PUBMED: 2834929] - PubMed
Staikou 2013 {published data only}
    1. Staikou C, Paraskeva A, Karmaniolou I, Vezakis A, Tsaroucha A. Intravenous lidocaine does not affect the anesthetic depth during rapid sequence induction and intubation as assessed by Bispectral Index monitoring: a randomized double blind study. Archives of Medical Science 2013; Vol. 9, issue 4:713‐8. [PUBMED: 24049534] - PMC - PubMed
Stoppe 2012 {published data only}
    1. Stoppe C, Peters D, Fahlenkamp AV, Cremer J, Rex S, Schalte G, et al. aepEX monitor for the measurement of hypnotic depth in patients undergoing balanced xenon anaesthesia. British Journal of Anaesthesia 2012;108(1):80‐8. [PUBMED: 22139005] - PubMed
Stuttmann 2010 {published data only}
    1. Stuttmann R, Jakubetz J, Schultz K, Schäfer C, Langer S, Ullmann U, et al. Recovery index, attentiveness and state of memory after xenon or isoflurane anaesthesia: a randomized controlled trial. Anesthesiology 2010;10:5. [PUBMED: 20459661] - PMC - PubMed
Toft 1987 {published data only}
    1. Toft P, Romer U. Comparison of midazolam and diazepam to supplement total intravenous anaesthesia with ketamine for endoscopy. Canadian Journal of Anaesthesia 1987;34(5):466‐9. [PUBMED: 3311432] - PubMed
Toscano 2007 {published data only}
    1. Toscano A, Pancaro C, Peduto VA. Scopolamine prevents dreams during general anesthesia. Anaesthesiology 2007;106(5):952‐5. [PUBMED: 17457126] - PubMed
Tsai 2001 {published data only}
    1. Tsai PS, Huang CJ, Hung YC, Cheng CR. Effects on the bispectral index during elective caesarean section: a comparison of propofol and isoflurane. Acta Anaesthesiologica Sinica 2001;39:17‐22. [PUBMED: 11407290] - PubMed
Tunstall 1989 {published data only}
    1. Tunstall ME, Sheikh A. Comparison of 1.5% enflurane with 1.25% isoflurane in oxygen for caesarean section: avoidance of awareness without nitrous oxide. British Journal of Anaesthesia 1989;62(2):138‐43. [PUBMED: 2923765] - PubMed
Vakkuri 2005 {published data only}
    1. Vakkuri A, Yli‐Hankala A, Sandin R, Mustola S, Hoymork S, Nyblom S, et al. Spectral entropy monitoring is associated with reduced propofol use and faster emergence in propofol‐nitrous oxide‐alfentanil anesthesia. Anesthesiology 2005;103(2):274‐9. [PUBMED: 16052109] - PubMed
van der Maaten 1996 {published data only}
    1. Maaten JM, Epema AH, Huet RC, Hennis PJ. The effect of midazolam at two plasma concentrations of hemodynamics and sufentanil requirement in coronary artery surgery. Journal of Cardiothoracic and Vascular Anesthesia 1996;10(3):356‐63. [PUBMED: 8725417] - PubMed
van Leeuwen 1990 {published data only}
    1. Leeuwen L, Zuurmond WW, Deen L, Helmers HJ. Total intravenous anaesthesia with propofol, alfentanil, and oxygen‐air: three different dosage schemes. Canadian Journal of Anaesthesiology 1990;37(3):282‐6. [PUBMED: 2182204] - PubMed
Wang 2013 {published data only}
    1. Wang J, Ren Y, Zhu Y, Chen JW, Zhu MM, Xu YJ, et al. Effect of penehyclidine hydrochloride on the incidence of intra‐operative awareness in Chinese patients undergoing breast cancer surgery during general anaesthesia. Anaesthesia 2013;68(2):136‐41. [PUBMED: 23237605] - PubMed
White 2003 {published data only}
    1. White PF, Wang B, Tang J, Wender RH, Naruse R, Sloninsky A. The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery. Anesthesia and Analgesia 2003;97(6):1633‐8. [PUBMED: 14633533] - PubMed
White 2004 {published data only}
    1. White PF, Ma H, Tang J, Wender RH, Sloninsky A, Kariger R. Does the use of electroencephalographic bispectral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting?. Anesthesiology 2004;100(4):811‐7. [PUBMED: 15087615] - PubMed
Wong 2002 {published data only}
    1. Wong J, Song D, Blanshard H, Grady D, Chung F. Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries. Canadian Journal of Anaesthesia 2002;49(1):13‐8. [PUBMED: 11782323] - PubMed
Wu 2001 {published data only}
    1. Wu CC, Mok MS, Lin CS, Han SR. EEG‐bispectral index changes with ketamine versus thiamylal induction of anesthesia. Acta Anaesthesiologica Sinica 2001;39(1):11‐5. [PUBMED: 11407289] - PubMed
Yildiz 2002 {published data only}
    1. Yildiz K, Esmaoglu A, Dogru K, Tercan E, Boyaci A. A comparison of alfentanil and remifentanil accompanying with BIS monitorization for total intravenous anaesthesia. Türk Anesteziyoloji ve Reanimasyon Derneği Dergisi [Journal of the Turkish Anaesthesiology and Intensive Care Society] 2002;30:309‐14.
Yoshitani 2003 {published data only}
    1. Yoshitani K, Kawaguchi M, Takahashi M, Kitaguchi K, Furuya H. Plasma propofol concentration and EEG burst suppression ratio during normothermic cardiopulmonary bypass. British Journal of Anaesthesia 2003;90(2):122‐6. [PUBMED: 12538365] - PubMed
Zhang 2011 {published and unpublished data}
    1. Zhang C, Xu L, Ma YQ, Sun YX, Li YH, Zhang L, et al. Bispectral index monitoring prevent awareness during total intravenous anesthesia: a prospective, randomized, double‐blinded, multi‐center controlled trial. Chinese Medical Journal 2011;124(22):3664‐9. [PUBMED: 22340221] - PubMed
Zhou 2008 {published data only}
    1. Zhou S‐L, Zhang R, Shen N, Wei J‐Q, Hei Z‐Q. Comparison of induction anesthesia with sevoflurane inhalation and intravenous propofol in gynaecologic laparoscopy operation. Zhongguo Xin Yao Za Zhi [Chinese Journal of New Drugs] 2008;17(21):1880‐3.
Zohar 2006 {published data only}
    1. Zohar E, Luban I, White PF, Ramati E, Shabat S, Fredman B. Bispectral index monitoring does not improve early recovery of geriatric outpatients undergoing brief surgical procedures. Canadian Journal of Anaesthesiology 2006;53(1):20‐5. [PUBMED: 16371605] - PubMed

References to studies excluded from this review

Abboud 1990 {published data only}
    1. Abboud TK, Afrasiabi A, Davidson J, Zhu J, Reyes A, Khoo N, et al. Prophylactic oral naltrexone with epidural morphine: effect on adverse reactions and ventilatory responses to carbon dioxide. Anesthesiology 1990;72(2):233‐7. [PUBMED: 2105673] - PubMed
Abdel‐Meguid 2005 {published data only}
    1. Abdel‐Meguid ME. Bispectral index guided evaluation of the optimal midazolam induction dosing for coronary revascularization. Egyptian Journal of Anaesthesia 2003;21(2):101‐4.
Abott 1980 {published data only}
    1. Abott TR, Bentley G. Intra‐operative awakening during scoliosis surgery. Anaesthesia 1980;35(3):298‐302. [MEDLINE: ] - PubMed
Abouleish 1976 {published data only}
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Absalom 2002 {published data only}
    1. Absalom AR, Sutcliffe N, Kenny GN. Closed‐loop control of anesthesia using bispectral index: performance assessment in patients undergoing major orthopedic surgery under combined general and regional anesthesia. Anesthesiology 2002;96(1):67‐73. [PUBMED: 11753004] - PubMed
Acil 2004 {published data only}
    1. Acil M, Basgul E, Celiker V, Karagoz AH, Demir B. Perioperative effects of melatonin and midazolam premedication on sedation, orientation, anxiety scores and psychomotor performance. European Journal of Anesthesiology 2004;21(7):553‐7. [PUBMED: 15318468] - PubMed
Adams 1998 {published data only}
    1. Adams DC, Hilton HJ, Madigan JD, Szerlip NJ, Cooper LA, Emerson RG. Evidence for unconscious memory processing during elective cardiac surgery. Circulation 1998;98(19 Suppl):II289‐92; discussion II292‐3. [PUBMED: 9852916] - PubMed
Adams 2003 {published data only}
    1. Adams HA, Meyer P, Stoppa A, Muller‐Goch A, Bayer P, Hecker H. Anaesthesia for caesarean section. Comparison of two general anaesthetic regimens and spinal anaesthesia. Der Anaesthesist 2003;52(1):23‐32. [PUBMED: 12577162] - PubMed
Ahmad 2003 {published data only}
    1. Ahmad S, Yilmaz M, Marcus RJ, Glisson S, Kinsella A. Impact of bispectral index monitoring on fast tracking of gynecologic patients undergoing laparoscopic surgery. Anesthesiology 2003;98(4):849‐52. [PUBMED: 12657845] - PubMed
Ahonen 2007 {published data only}
    1. Ahonen J, Jokela R, Uutela K, Huiku M. Surgical stress index reflects surgical stress in gynaecological laparoscopic day‐case surgery. British Journal of Anaesthesia 2007;98(4):456‐61. [PUBMED: 17350969] - PubMed
Alexander 1999a {published data only}
    1. Alexander R, Booth J, Olufolabi AJ, El‐Moalem HE, Glass PS. Comparison of remifentanil with alfentanil or suxamethonium following propofol anaesthesia for tracheal intubation. Journal of Anesthesia 1999;54(11):1032‐6. [PUBMED: 10540090] - PubMed
Alexander 1999b {published data only}
    1. Alexander R, Olufolabi AJ, Booth J, El‐Moalem HE, Glass PS. Dosing study of remifentanil and propofol for tracheal intubation without the use of muscle relaxants. Anaesthesia 1999;54(11):1037‐40. [PUBMED: 10540091] - PubMed
Al‐Ruzzeh 2006 {published data only}
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Alvarez 2000 {published data only}
    1. Alvarez AO, Cascardo A, Albarracin Menendez S, Capria JJ, Cordero RA. Total intravenous anesthesia with midazolam, remifentanil, propofol and cisatracurium in morbid obesity. Obesity Surgery 2000;10(4):353‐60. [PUBMED: 11007629] - PubMed
Andelman 2004 {published data only}
    1. Andelman F, Zuckerman‐Feldhay E, Hoffien D, Fried I, Neufeld MY. Lateralization of deficit in self‐awareness of memory in patients with intractable epilepsy. Epilepsia 2004;45(7):826‐33. [PUBMED: 15230708] - PubMed
Anderson 2003 {published data only}
    1. Anderson RE, Barr G, Assareh H, Jakobsson J. The AAI index, the BIS index and end‐tidal concentration during wash in and wash out of sevoflurane. Journal of Anesthesia 2003;58(6):531‐5. [PUBMED: 12846616] - PubMed
Anderson 2004 {published data only}
    1. Anderson RE, Barr G, Owall A, Jakobsson J. Entropy during propofol hypnosis, including an episode of wakefulness. Journal of Anesthesia 2004; Vol. 59, issue 1:52‐6. [PUBMED: 14687099] - PubMed
Andrade 2001 {published data only}
    1. Andrade J, Englert L, Harper C, Edwards ND. Comparing the effects of stimulation and propofol infusion rate on implicit and explicit memory formation. British Journal of Anaesthesia 2001; Vol. 86, issue 2:189‐95. [PUBMED: 11573658] - PubMed
Aono 1999 {published data only}
    1. Aono J, Mamiya K, Manabe M. Preoperative anxiety is associated with a high incidence of problematic behavior on emergence after halothane anesthesia in boys. Acta Anaesthesiologica Scandinavica 1999;43(5):542‐4. [PUBMED: 10342002] - PubMed
Apfelbaum 1996 {published data only}
    1. Apfelbaum JL, Lichtor JL, Lane BS, Coalson DW, Korttila KT. Awakening, clinical recovery, and psychomotor effects after desflurane and propofol anesthesia. Anesthesia and Analgesia 1996;83(4):721‐5. [PUBMED: 8831309] - PubMed
Aqil 2009 {published data only}
    1. Aqil M, Aziz‐ul‐Haq, Rasheed A, Altaf R. Effect of two different doses of fentanyl on intubating conditions with sevoflurane inhalation without neuromuscular blocking agents in adults. Anaesthesia, Pain & Intensive Care 2009;13(2):55‐6.
Arndt 1995a {published data only}
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Aubrun 2008 {published data only}
    1. Aubrun F, Gaillat C, Rosenthal D, Dupuis M, Mottet P, Marchetti F, et al. Effect of a low‐dose ketamine regimen on pain, mood, cognitive function and memory after major gynaecological surgery: a randomized, double‐blind, placebo‐controlled trial. European Journal of Anaesthesiology 2008;25(2):97‐105. [PUBMED: 17894912] - PubMed
Ausems 1983 {published data only}
    1. Ausems ME, Hug CCJ, Lange S. Variable rate infusion of alfentanil as a supplement to nitrous oxide anesthesia for general surgery. Anesthesia and Analgesia 1983;62(11):982‐6. [PUBMED: 6414340] - PubMed
Ausems 1986 {published data only}
    1. Ausems ME, Hug CC Jr, Stanski DR, Burm AG. Plasma concentrations of alfentanil required to supplement nitrous oxide anesthesia for general surgery. Anesthesiology 1986; Vol. 65, issue 4:362‐73. [PUBMED: 3094407] - PubMed
Bailey 1985 {published data only}
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Balci 2006 {published data only}
    1. Balci C, Akbulutt G, Ibis AH, Arikan Y. Comparison of desflurane and sevoflurane recovery duration with BIS values. Anestezi Dergisi [Journal of Anesthesia] 2006;14(1):32‐6.
Bannister 2001 {published data only}
    1. Bannister CF, Brosius KK, Sigl JC, Meyer BJ, Sebel PS. The effect of bispectral index monitoring on anesthetic use and recovery in children anesthetized with sevoflurane in nitrous oxide. Anesthesia and Analgesia 2001;92(4):877‐81. [PUBMED: 11273918] - PubMed
Baraka 1990 {published data only}
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Barclay 1980 {published data only}
    1. Barclay A, Houlton PC, Downing JW. Total intravenous anaesthesia: a technique using flunitrazepam, ketamine, muscle relaxants and controlled ventilation of the lung. Anaesthesia 1980;35(3):287‐90. [PUBMED: 6104936] - PubMed
Barr 1973 {published data only}
    1. Barr AM, Wong RM. Awareness during general anaesthesia for bronchoscopy and laryngoscopy using the apnoeic oxygenation technique. British Journal of Anaesthesia 1973;45(8):894‐900. [PUBMED: 4753687] - PubMed
Barr 1999 {published data only}
    1. Barr G, Jakobsson JG, Owall A, Anderson RE. Nitrous oxide does not alter bispectral index: study with nitrous oxide as sole agent and as an adjunct to i.v. anaesthesia. British Journal of Anaesthesia 1999;82(6):827‐30. [PUBMED: 10562773] - PubMed
Barr 2001 {published data only}
    1. Barr G, Anderson RE, Owall A, Jakobsson JG. Being awake intermittently during propofol‐induced hypnosis: a study of BIS, explicit and implicit memory. Acta Anaesthesiologica Scandinavica 2001;45(7):834‐8. [PUBMED: 11472283] - PubMed
Barvais 2003 {published data only}
    1. Barvais L, Engelman E, Eba JM, Coussaert E, Cantraine F, Kenny GN. Effect site concentrations of remifentanil and pupil response to noxious stimulation. British Journal of Anaesthesia 2003; Vol. 91, issue 3:347‐52. [PUBMED: 12925472] - PubMed
Basar 2003 {published data only}
    1. Basar H, Ozcan S, Buyukkocak U, Akpinar S, Apan A. Effect of bispectral index monitoring on sevoflurane consumption. European Journal of Anaesthesiology 2003; Vol. 20, issue 5:396‐400. [PUBMED: 12790212] - PubMed
Becker‐Blease 2006 {published data only}
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    1. Bejjani G, Lequeux PY, Schmartz D, Engelman E, Barvais L. No evidence of memory processing during propofol‐remifentanil target‐controlled infusion anesthesia with bispectral index monitoring in cardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia 2009;23(2):175‐81. [PUBMED: 19026570] - PubMed
Bennett 1985 {published data only}
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Bilotta 2007 {published data only}
    1. Bilotta F, Caramia R, Paoloni FP, Favaro R, Araimo F, Pinto G, et al. Early postoperative cognitive recovery after remifentanil‐propofol or sufentanil‐propofol anaesthesia for supratentorial craniotomy: a randomized trial. European Journal of Anaesthesiology 2007; Vol. 24, issue 2:122‐7. [PUBMED: 16938153] - PubMed
Bischoff 1997 {published data only}
    1. Bischoff P. Intracranial pressure and anesthesia‐‐EEG and p‐EEG monitoring. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie 1997;32(2 Suppl):122‐7. [PUBMED: 9417237] - PubMed
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Bogetz 1984 {published data only}
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Bogod 1990 {published data only}
    1. Bogod DG, Orton JK, Yau HM, Oh TE. Detecting awareness during general anaesthetic caesarean section. An evaluation of two methods. Journal of Anesthesia 1990; Vol. 45, issue 4:279‐84. [PUBMED: 2337210] - PubMed
Bonhomme 2006 {published data only}
    1. Bonhomme V, Llabres V, Dewandre PY, Brichant JF, Hans P. Combined use of Bispectral Index and A‐Line Autoregressive Index to assess anti‐nociceptive component of balanced anaesthesia during lumbar arthrodesis. British Journal of Anaesthesia 2006; Vol. 96, issue 3:353‐60. [PUBMED: 16415310] - PubMed
Bonke 1986 {published data only}
    1. Bonke B, Schmitz PI, Verhage F, Zwaveling A. Clinical study of so‐called unconscious perception during general anaesthesia. British Journal of Anaesthesia 1986;58(9):957‐64. [PUBMED: 3756055] - PubMed
Bonke 1992 {published data only}
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Bould 2007 {published data only}
    1. Bould MD, Mahtani DG, Davies R, Roughton M, Hunter DN, Kelleher A. Bispectral index values during elective rigid bronchoscopy: a prospective observational pilot study. Anaesthesia 2007;62:438‐45. [PUBMED: 17448053] - PubMed
Brice 1970 {published data only}
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Brosius 2002 {published data only}
    1. Brosius KK, Bannister CF. Oral midazolam premedication in preadolescents and adolescents. Anesthesia and Analgesia 2002;94(1):31‐6, table of contents. [PUBMED: 11772796] - PubMed
Bruhn 2000 {published data only}
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Buffett‐Jerrott 2003 {published data only}
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Bulach 2005 {published data only}
    1. Bulach R, Myles PS, Russnak M. Double‐blind randomized controlled trial to determine extent of amnesia with midazolam given immediately before general anaesthesia. British Journal of Anaesthesia 2005;94(3):300‐5. [PUBMED: 15567810] - PubMed
Burn 1963 {published data only}
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Byers 1997 {published data only}
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Capitanio 1997 {published data only}
    1. Capitanio L, Jensen EW, Filligoi GC, Makovec B, Gagliardi M, Henneberg SW, et al. On‐line analysis of AEP and EEG for monitoring depth of anaesthesia. Methods of Information in Medicine 1997;36:311‐4. - PubMed
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Chortkoff 1995 {published data only}
    1. Chortkoff BS, Gonsowski CT, Bennett HL, Levinson B, Crankshaw DP, Dutton RC, et al. Subanesthetic concentrations of desflurane and propofol suppress recall of emotionally charged information. Anesthesia and Analgesia 1995; Vol. 81, issue 4:728‐36. [PUBMED: 7574002] - PubMed
Cirillo 2012 {published data only}
    1. Cirillo V, Volpe ML, Iacono C, Crisconio P, Robertis E, Tufano R. Is Navigator a useful tool in guiding anesthesia practice in nephropatic patients? Preliminary study. European Journal of Anaesthesiology 2012; Vol. 29:52.
Clark 2009 {published data only}
    1. Clark G, Licker M, Younossian AB, Soccal PM. Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial. European Respiratory Journal 2009;34(6):1277‐83. [PUBMED: 19443532] - PubMed
Coetzee 1998 {published data only}
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Coppens 2010 {published data only}
    1. Coppens M, Limmen JG, Schnider T, Wyler B, Bonte S. Study of the time course of the clinical effect of propofol compared with the time course of the predicted effect‐site concentration: performance of three pharmacokinetic‐dynamic models. British Journal of Anaesthesia 2010;104(4):452‐8. [PUBMED: 20190259] - PubMed
Cormack 1979 {published data only}
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Crawford 1976 {published data only}
    1. Crawford JS, James FM, 3rd, Davies P, Crawley M. A further study of general anaesthesia for Caesarean section. British Journal of Anaesthesia 1976;48(7):661‐7. [PUBMED: 1016643] - PubMed
Dahaba 2009 {published data only}
    1. Dahaba AA, Bornemann H, Rehak PH, Wang G, Wu XM, Metzler H. Effect of flumazenil on bispectral index monitoring in unpremedicated patients. Anesthesiology 2009;110(5):1036‐40. [PUBMED: 19352163] - PubMed
Dahaba 2010 {published data only}
    1. Dahaba AA, Xue JX, Zhao GG, Liu QH, Xu GX, Bornemann H, et al. BIS‐vista occipital montage in patients undergoing neurosurgical procedures during propofol‐remifentanil anesthesia. Anesthesiology 2010;112(3):645‐51. [PUBMED: 20179501] - PubMed
Davidson 2005 {published data only}
    1. Davidson AJ, Huang GH, Czarnecki C, Gibson MA, Stewart SA, Jamsen K, et al. Awareness during anesthesia in children: a prospective cohort study. Anesthesia and Analgesia 2005;100(3):653‐61, table of contents. [PUBMED: 15728046] - PubMed
Davies 1996 {published data only}
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De Cosmo 2008 {published data only}
    1. Cosmo G, Congedo E, Lai C, Sgreccia M, Amato A, Beccia G, et al. Ropivacaine vs. levobupivacaine combined with sufentanil for epidural analgesia after lung surgery. European Journal of Anaesthesiology 2008;25(12):1020‐5. [PUBMED: 18538053] - PubMed
De Kock 2005 {published data only}
    1. Kock M, Lavand'homme P, Waterloos H. The short‐lasting analgesia and long‐term antihyperalgesic effect of intrathecal clonidine in patients undergoing colonic surgery. Anesthesia and Analgesia 2005;101(2):566‐72. [PUBMED: 16037177] - PubMed
Ding 1993 {published data only}
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Ding 2007 {published data only}
    1. Ding LA, Sun LQ, Chen SX, Qu LL, Xie DF. Modified physiological and operative score for the enumeration of mortality and morbidity risk assessment model in general surgery. World Journal of Gastroenterology 2007;13(38):5090‐5. [PUBMED: 17876874] - PMC - PubMed
Diz 2010 {published data only}
    1. Diz JC, Rio R, Lamas A, Mendoza M, Duran M, Ferreira LM. Analysis of pharmacodynamic interaction of sevoflurane and propofol on Bispectral Index during general anaesthesia using a response surface model. British Journal of Anaesthesia 2010;104(6):733‐9. [PUBMED: 20385571] - PubMed
Doufas 2009 {published data only}
    1. Doufas AG, Komatsu R, Orhan‐Sungur M, Sengupta P, Wadhwa A, Mascha E, et al. Neuromuscular block differentially affects immobility and cortical activation at near‐minimum alveolar concentration anesthesia. Anesthesia and Analgesia 2009;109(4):1097‐104. [PUBMED: 19762737] - PubMed
Downing 1976 {published data only}
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Dressler 2007 {published data only}
    1. Dressler I, Fritzsche T, Cortina K, Pragst F, Spies C, Rundshagen I. Psychomotor dysfunction after remifentanil/propofol anaesthesia. European Journal of Anaesthesiology 2007;24(4):347‐54. [PUBMED: 17087850] - PubMed
Driscoll 2007 {published data only}
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Eisele 1976 {published data only}
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Ekman 2004a {published data only}
    1. Ekman A, Lindholm ML, Lennmarken C, Sandin R. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiologica Scandinavica 2004; Vol. 48, issue 1:20‐6. [PUBMED: 14674969] - PubMed
Ekman 2004b {published data only}
    1. Ekman A, Brudin L, Sandin R. A comparison of bispectral index and rapidly extracted auditory evoked potentials index responses to noxious stimulation during sevoflurane anesthesia. Anesthesia and Analgesia 2004; Vol. 99, issue 4:1141‐6, table of contents. [PUBMED: 15385365] - PubMed
Eldar 1992 {published data only}
    1. Eldar I, Lieberman N, Shiber R, Nerubay J, Perel A. Use of flumazenil for intraoperative arousal during spine fusion. Anesthesia and Analgesia 1992;75(4):580‐3. [PUBMED: 1530171] - PubMed
El‐Kerdawy 2000 {published data only}
    1. El‐Kerdawy HM, Zalingen EE, Bovill JG. The influence of the alpha2‐adrenoceptor agonist, clonidine, on the EEG and on the MAC of isoflurane. European Journal of Anaesthesiology 2000; Vol. 17, issue 2:105‐10. [PUBMED: 10758454] - PubMed
Erhan 2003 {published data only}
    1. Erhan E, Ugur G, Gunusen I, Alper I, Ozyar B. Propofol ‐ not thiopental or etomidate ‐ with remifentanil provides adequate intubating conditions in the absence of neuromuscular blockade. Canadian Journal of Anaesthesia 2003; Vol. 50, issue 2:108‐15. [PUBMED: 12560298] - PubMed
Erk 2007 {published data only}
    1. Erk G, Ornek D, Donmez NF, Taspinar V. The use of ketamine or ketamine‐midazolam for adenotonsillectomy. International Journal of Pediatric Otorhinolaryngology 2007; Vol. 71, issue 6:937‐41. [PUBMED: 17418428)] - PubMed
Eroglu 2003 {published data only}
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Evans 1988 {published data only}
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    1. Fahlenkamp AV, Krebber F, Rex S. Bispectral index monitoring during balanced xenon or sevoflurane anaesthesia in elderly patients. European Journal of Anesthesiology 2010;27(10):906‐11. [PUBMED: [20671557]] - PubMed
Fairley 1956 {published data only}
    1. Fairley HB. An evaluation of local and general anaesthesia for diagnostic bronchoscopy. Canadian Anaesthetists' Society Journal 1956;3(4):366‐77.
Famewo 1976 {published data only}
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Farag 2006 {published data only}
    1. Farag E, Chelune GJ, Schubert A, Mascha EJ. Is depth of anesthesia, as assessed by the Bispectral Index, related to postoperative cognitive dysfunction and recovery?. Anesthesia and Analgesia 2006; Vol. 103, issue 3:633‐40. [PUBMED: 16931673] - PubMed
Filipov 2007 {published data only}
    1. Filipov TZ, Smilov IV. Comparison of the quality of anesthesia between two techniques ascertained with bispectral index. Anaesthesiology and Intensive Care 2007;34:3‐13.
Fisher 2006 {published data only}
    1. Fisher J, Hirshman E, Henthorn T, Arndt J, Passannante A. Midazolam amnesia and short‐term/working memory processes. Consciousness and Cognition 2006; Vol. 15, issue 1:54‐63. [PUBMED: 16546038] - PubMed
Fitzgerald 2001 {published data only}
    1. Fitzgerald RD, Lamm C, Oczenski W, Stimpfl T, Vycudilik W, Bauer H. Direct current auditory evoked potentials during wakefulness, anesthesia, and emergence from anesthesia. Anesthesia and Analgesia 2001; Vol. 92, issue 1:154‐60. [PUBMED: [11133619]] - PubMed
Flaishon 1997 {published data only}
    1. Flaishon R, Windsor A, Sigl J, Sebel PS. Recovery of consciousness after thiopental or propofol. Bispectral index and isolated forearm technique. Anesthesiology 1997; Vol. 86, issue 3:613‐9. [PUBMED: [9066327]] - PubMed
Flaitz 1986 {published data only}
    1. Flaitz CM, Nowak AJ, Hicks MJ. Evaluation of the anterograde amnesic effect of rectally administered diazepam in the sedated pedodontic patient. ASDC Journal of Dentistry for Children 1986; Vol. 53, issue 1:17‐20. [PUBMED: [3455953]] - PubMed
Flier 1986 {published data only}
    1. Flier FJ, Smorenburg JM, Ent CK, Bonke B, Rupreht J. Postanesthetic recall ability, anxiety and dreams in surgical patients. A clinical study. Der Anaesthesist 1986; Vol. 35, issue 10:609‐12. [PUBMED: [3789390]] - PubMed
Forrest 1990 {published data only}
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Frank 2000 {published data only}
    1. Frank T, Thieme V, Olthoff D. Clonidine within the scope of balanced inhalation anesthesia with sevoflurane‐‐effects on pEEG parameters [Clonidin im Rahmen einer balancierten Inhalationsanasthesie mit Sevofluran‐‐Effekte auf Parameter des pEEG.]. Anaesthesiologie und Reanimation 2000;25(2):32‐6. [PUBMED: 10816895] - PubMed
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    1. Fung NY, Hu Y, Irwin MG, Chow BE, Yuen MY. Comparison between sevoflurane/remifentanil and propofol/remifentanil anaesthesia in providing conditions for somatosensory evoked potential monitoring during scoliosis corrective surgery. Anaesthesia and Intensive Care 2008;36(6):779‐85. [PUBMED: 19115644] - PubMed
Gajraj 1998 {published data only}
    1. Gajraj RJ, Doi M, Mantzaridis H, Kenny GN. Analysis of the EEG bispectrum, auditory evoked potentials and the EEG power spectrum during repeated transitions from consciousness to unconsciousness. British Journal of Anaesthesia 1998; Vol. 80, issue 1:46‐52. [PUBMED: [9505777]] - PubMed
Gajraj 1999 {published data only}
    1. Gajraj RJ, Doi M, Mantzaridis H, Kenny GN. Comparison of bispectral EEG analysis and auditory evoked potentials for monitoring depth of anaesthesia during propofol anaesthesia. British Journal of Anaesthesia 1999; Vol. 82, issue 5:672‐8. [PUBMED: [10536541]] - PubMed
Gan 1997 {published data only}
    1. Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, et al. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology 1997; Vol. 87, issue 4:808‐15. [PUBMED: [9357882]] - PubMed
Gan 1999 {published data only}
    1. Gan TJ, Glass PS, Sigl J, Sebel P, Payne F, Rosow C, et al. Women emerge from general anesthesia with propofol/alfentanil/nitrous oxide faster than men. Anesthesiology May;90(5):1283‐7. [PUBMED: 10319774] - PubMed
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Hadzidiakos 2006 {published data only}
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Iselin‐Chaves 2000 {published data only}
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    1. Lehmann A, Zeitler C, Thaler E, Isgro F, Boldt J. Comparison of two different anesthesia regimens in patients undergoing aortocoronary bypass grafting surgery: sufentanil‐midazolam versus remifentanil‐propofol. Retractions. [J Cardiothorac Vasc Anesth. 2011]. Journal of Cardiothoracic and Vascular Anesthesia 2000;14(4):416‐20. [PUBMED: 10972607] - PubMed
Lehmann 2002 {published data only}
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Lehmann 2003 {published data only}
    1. Lehmann A, Karzau J, Boldt J, Thaler E, Lang J, Isgro F. Bispectral index‐guided anesthesia in patients undergoing aortocoronary bypass grafting. Retraction inBispectral index‐guided anesthesia in patients undergoing aortocoronary bypass grafting: Retraction. [Anesth Analg. 2011]. Anaesthesia and Analgesia 2003;96:336‐43. [PUBMED: 12538174] - PubMed
Lequeux 2003 {published data only}
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Liao 2010 {published data only}
    1. Liao R, Li JY, Liu GY. Comparison of sevoflurane volatile induction/maintenance anaesthesia and propofol‐remifentanil total intravenous anaesthesia for rigid bronchoscopy under spontaneous breathing for tracheal/bronchial foreign body removal in children. European Journal of Anaesthesiology 2010;27(11):930‐4. [PUBMED: 20683333] - PubMed
Liou 1994 {published data only}
    1. Liou CM, Kang HM, Lai HC, Liu YC, Hung CJ, Wang SJ, et al. Will epidural with light general anesthesia increase the incidence of awareness with recall or dream postoperatively. Acta Anaesthesiologica Sinica 1994;32(4):229‐36. [PUBMED: 7894918] - PubMed
Liu 2005 {published data only}
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Liu 2006 {published data only}
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Liu 2009 {published data only}
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Lopez 2007 {published data only}
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Low 2007 {published data only}
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Luginbuhl 2007 {published data only}
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Malek 2010 {published data only}
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Malviya 2009 {published data only}
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Mi 1999 {published data only}
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Moustafa 2008 {published data only}
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Nelskyla 2001 {published data only}
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Reinhart 1985 {published data only}
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Samuelsson 2007 {published data only}
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Schwender 1997 {published data only}
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Schwieger 1989 {published data only}
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Spaulding 1984 {published data only}
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Vanacker 2002 {published data only}
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Wang 2005 {published data only}
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Wang 2007 {published data only}
    1. Wang SM, Constable RT, Tokoglu FS, Weiss DA, Freyle D, Kain ZN. Acupuncture‐induced blood oxygenation level‐dependent signals in awake and anesthetized volunteers: a pilot study. Anesthesia and Analgesia 2007;105(2):499‐506. [PUBMED: 17646512] - PubMed
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    1. Weber F, Kriek N, Blusse H. Conference: European Anaesthesiology Congress, EUROANAESTHESIA 2009 Milan Italy; Influence of a muscle relaxant bolus on BIS, Cerebral State Index (CSI) and Spectral Edge Frequency (SEF) in children under propofol anaesthesia.. Euroanaesthesia 2009;26:144.
Wellisch 2012 {published data only}
    1. Wellisch OM, Kronenfeld M, Saberito D, Pagala M, Choueka J, Gupta P. A prospective randomized controlled trial comparing the efficacy and safety of dexmedetomidine versus propofol TIVA in conjunction with regional block for shoulder surgery in beach chair sitting position. Regional Anesthesia and Pain Medicine 2012;0(6):1.
Wihelm 2000 {published data only}
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    1. Wang Y, Yue Y, Sun YH, Wu AS, Wu QW, Zhang YQ, et al. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China. Chinese Medical Journal 2005;118(14):1190‐4. [PUBMED: 16117864] - PubMed
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Yan 2014 {published data only}
    1. Yan J, Lin CQ, Zhang CZ, Ou JY, Luo FR, Zhang SL, et al. Effects of assisted‐electroacupuncture on recovery of fast tracking anesthesia in mPCNL. Zhongguo Zhen Jiu [Chinese Acupuncture & Moxibustion] 2014;34(4):385‐8. - PubMed
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Yeh 2009 {published data only}
    1. Yeh YC, Lin TF, Chang HC, Chan WS, Wang YP, Lin CJ, et al. Combination of low‐dose nalbuphine and morphine in patient‐controlled analgesia decreases incidence of opioid‐related side effects. Journal of the Formosan Medical Association 2009;108(7):548‐53. [PUBMED: 19586828] - PubMed
Yi 2008 {published data only}
    1. Yi C, Jee D. Influence of the anaesthetic depth on the inhibition of the oculocardiac reflex during sevoflurane anaesthesia for paediatric strabismus surgery. British Journal of Anaesthesia 2008;101(2):234‐8. [PUBMED: 18524784] - PubMed
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References to studies awaiting assessment

Aceto 2015 {published data only}
    1. Aceto P, Perilli V, Lai C, Sacco T, Modesti C, Luca E, et al. Minimum alveolar concentration threshold of sevoflurane for postoperative dream recall. Minerva Anestesiologica 2015; Vol. 81, issue 11:1201‐9. - PubMed
Asouhidou 2015 {published data only}
    1. Asouhidou I, Trikoupi A. Esmolol reduces anesthetic requirements thereby facilitating early extubation; a prospective controlled study in patients undergoing intracranial surgery. BMC Anesthesiology 2015;15(11):172. - PMC - PubMed
Elbadawy 2015 {published data only}
    1. Elbadawy AM, Khidr AM, Saleh AA. Comparative study of implicit memory during bispectral index guided total intravenous anesthesia versus sevoflurane inhalation anesthesia. Egyptian Journal of Anaesthesia 2015;31(1):9‐13.
Hoymork 2007 {published data only}
    1. Hoymork SC, Hval K, Jensen EW, Raeder J. Can the cerebral state monitor replace the bispectral index in monitoring hypnotic effect during propofol/remifentanil anaesthesia?. Acta Anaesthesiologica Scandinavia 2007;51(2):210‐6. [PUBMED: 17330331] - PubMed
Jiang 2016 {published data only}
    1. Jiang A, Chen LJ, Wang YX, Li MC, Ding YB. The effects of different methods of anaesthesia for laparoscopic radical gastrectomy with monitoring of entropy. Anticancer Research 2016;36(3):1305‐8. - PubMed
Khanjani 2014 {published data only}
    1. Khanjani S, Naghibi K, Azarnoush H. Awareness and Apgar score in elective Cesarean section under general anesthesia with propofol or Isoflurane: a prospective, randomized, double‐blinded clinical trial study. Advances in Biomedical Engineering Research 2014;3:234. - PMC - PubMed
Lequeux 2014 {published data only}
    1. Lequeux PY, Hecquet F, Bredas P. Does anesthetic regimen influence implicit memory during general anesthesia?. Anesthesia and Analgesia 2014;119(5):1174‐9. - PubMed
Mehmandoost 2013 {published data only}
    1. Mehmandoost MK, Naghibi K. Comparative study of the effects of two anesthetic methods with propofol and isoflurane on mother's awareness during the operation and Apgar score in the newborns delivered by elective cesarean section. Journal of Isfahan Medical School; http://english.mui.ac.ir/content/iums‐journals 2013;31(228):265‐73.
Rajan 2015 {published data only}
    1. Rajan S, Hassain A, Puthenveettil N, Kumar L. Efficacy and safety of low‐dose ketamine as an adjunct analgesic and amnesic during caesarean section under general anaesthesia. Indian Journal of Anaesthesia 2015;59(10):653‐7. - PMC - PubMed
Xie 2015 {published data only}
    1. Xie M, Lan ZX, Liu YF. Effects of sevoflurane and propofol on preoperative implicit and explicit memories in general anaesthesia patients of elective surgery: a randomized controlled trial. Chinese Journal of Evidence‐Based Medicine 2015;15(9):1000‐4.

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References to other published versions of this review

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