Author: Zhou, Li et al.
Anesthesiology ():10.1097/ALN.0000000000005770, September 25, 2025. doi:10.1097/ALN.0000000000005770
This large multicenter, randomized, double-blind trial tested whether Bispectral Index (BIS) monitoring improves long-term outcomes in older adults undergoing elective non-cardiac surgery. The study included 6,982 patients aged 65 years or older across 21 hospitals in China. Patients were randomized to BIS-guided anesthesia (maintaining BIS 40–60) or routine anesthetic management without visible BIS data.
Results showed no difference in hypnotic depth between groups: BIS values averaged 47 in the BIS-guided group and 46 in the routine group. One-year all-cause mortality was nearly identical (10.2% vs 10.0%). Rates of moderate-to-severe complications within 30 days were also similar (10.4% vs 10.6%). Measures of functional independence, quality of life, ICU admissions, and hospital cost did not differ between groups.
The authors concluded that anesthesiologists titrate anesthetic depth effectively based on clinical judgment alone. BIS monitoring did not provide measurable benefits in mortality, complications, or recovery in this population.
What You Should Know
BIS monitoring did not improve survival, complication rates, or recovery outcomes in older surgical patients. Experienced anesthesiologists appear to achieve appropriate hypnotic depth without relying on BIS guidance.
Thank you Anesthesiology for publishing this article.