A randomized controlled trial of anesthesia guided by bispectral index versus standard care: Effects on cognition

Zohn Centimole, John Eichhorn, Susan K. Frazier, Gregory A. Jicha, Mary Kay Rayens, John F. Watkins, Sarah F. Centimole, Debra K. Moser

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Postoperative cognitive dysfunction, a subtle deterioration of cognitive function after exposure to anesthetics, is reported in 10% to 50% of surgical cases. Delivery of excessive inhalation anesthetics based on minimum alveolar concentration produces greater deep hypnotic times, which may contribute to postoperative cognitive dysfunction. This study tested the impact on cognitive function of balanced anesthetic using electroencephalographic (EEG) guidance vs usual anesthesia. We studied 88 surgical patients: 45 randomly assigned to balanced anesthetic technique with EEG guidance and 43 to standard treatment. Cognitive function was evaluated with the Cambridge Neuropsychological Test Automated Battery-Mild Cognitive Impairment at 3 intervals (preoperatively, 3-5 days postoperatively, and 3-5 months postoperatively). Additionally, 37 age- and sex-matched individuals not undergoing surgery or anesthesia were evaluated at the same intervals. Better outcomes were seen in the intervention group compared with usual care in the short-term/visual memory cognitive domain (P = .02) at 3 to 5 days, but not at 3 to 5 months. Delivery of anesthesia using EEG monitoring systems can reduce cumulative deep hypnotic time without negatively affecting patient physiologic stress, surgical conditions, or cognitive function. Our findings provide data to support optimal anesthetic approaches to improve cognitive function after anesthesia with volatile anesthetics.

Original languageEnglish
Pages (from-to)115-123
Number of pages9
JournalAANA Journal
Issue number2
StatePublished - 2019

Bibliographical note

Funding Information:
This study was funded by a grant from the AANA Foundation, Park Ridge, Illinois. Additional funding was received from the National Institutes of Health, National Institute of Nursing Research, Bethesda, Maryland (D. K. Moser and G. A. Jicha, principal investigators, grant No. 1R01NR014189). Disclosure statements are available for viewing upon request. The authors thank the physicians and nurse anesthetists from the University of Kentucky Department of Anesthesiology, the staff and especially the nurse practitioners of the Preoperative Clinic, and the surgeons of the University of Kentucky, notably Sandra Beck, MD, and Phillip Tibbs, MD. This study is dedicated to Vicki Gibson, CRNA, an exceptional colleague and even better friend.

Publisher Copyright:
© 2019 AANA Publishing Inc. All rights reserved.


  • Anesthesia technique
  • Mild cognitive impairment
  • Postoperative cognitive dysfunction

ASJC Scopus subject areas

  • Medical–Surgical
  • Advanced and Specialized Nursing
  • Anesthesiology and Pain Medicine


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