Min Shi,* Yufang Long,* Zhihu Zhou, Liqiao Huang, Danping Wu, Xu Zhang

Department of Anesthesiology, The Second Affiliated Hospital of Guilin Medical University, Guilin, 541199, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xu Zhang, Department of Anesthesiology, The Second Affiliated Hospital of Guilin Medical University, No. 212 Renmin Road, Guilin, 541199, People’s Republic of China, Tel +86 189 3477 9973, Email zhangxu@glmc.edu.cn

Purpose: To comprehensively evaluate the impact of bispectral index (BIS) monitoring-guided anesthesia depth on the early recovery quality in elderly patients undergoing laparoscopic surgery.
Methods: Ninety patients aged ≥ 60 years scheduled for laparoscopic surgery under general anesthesia were randomized into three groups: Group C (empirically guided anesthesia), Group B1 (BIS-guided, target range 40– 60), and Group B2 (BIS-guided, target range 50– 60). Blinded researchers evaluated recovery quality (QoR-15), pain (VAS), and sleep (RCSQ) preoperatively and on postoperative days 1, 2, 3, and 7 (POD1,2,3,7). Postoperative delirium was assessed with CAM (POD1–POD3), and cognitive function (MMSE) was measured preoperatively, POD3, and POD7. Intraoperative data included vital signs, BIS values, anesthetic dosage, emergence/extubation times, PACU stay, and adverse events within three days post-surgery. Time to first ambulation and hospital stay were also recorded.
Results: Compared with Group C, Group B1 and B2 had lower propofol consumption, shorter emergence/extubation times, and higher BIS values (T2-T5 and overall mean) (P< 0.05). QoR-15 scores improved on POD2 in Group B1 and on both POD1 and POD2 in Group B2 (P< 0.05). The RCSQ scores increased on POD1 and POD3 in Group B1 (P< 0.05) and on POD1, POD2 and POD3 in Group B2 (P< 0.05). In addition, Group B2 had a shorter PACU stay and time to first postoperative ambulation (P< 0.05). No differences were found in the incidence of postoperative delirium, POCD, or MMSE scores among the three groups. Compared to Group B1, Group B2 exhibited shorter emergence and extubation times, elevated BIS values at T3 and T5, a higher mean BIS value throughout surgery, and enhanced QoR-15 scores on POD1 and POD2 (P< 0.05).
Conclusion: BIS monitoring-guided anesthesia management can enhance early recovery from laparoscopic surgery in elderly patients with BIS values within a safe range, which may be particularly advantageous for this demographic during laparoscopic procedures.

Keywords: bispectral index, BIS, elderly patients, quality of postoperative recovery, cognitive function, sleep quality