PRISMA: accuracy of response entropy and bispectral index to predict the transition of consciousness during sevoflurane anesthesia: A systematic review and meta-analysis

BACKGROUND: Bispectral index (BIS) and response entropy (RE) are used to monitor the depth of anesthesia. OBJECTIVES: To collect published data and compare the accuracy of BIS and RE in detecting the transition of consciousness during sevoflurane anesthesia. DATA SOURCES: Studies indexed in the PubMed, Embase, or Cochrane databases. STUDY ELIGIBILITY CRITERIA: 1. Monitoring of sevoflurane anesthesia depth with BIS and RE simultaneously; 2. Use of prediction probability values to evaluate prediction accuracy; and 3. The full text of the published study is available and contains sufficient data for further analyses. PARTICIPANTS: Patients who need to use BIS and RE to monitor sevoflurane anesthesia depth simultaneously. INTERVENTIONS: A random-effects model was fitted using RevMan 5.3. Subgroup analyses were performed on patient age. The Cochrane I(2) methodology was used to determine the heterogeneity of the statistical results, while GRADE Pro served to assess the quality of evidence. RESULTS: Overall, 195 articles were identified, of which 7 were finally included. The meta-analysis results showed that BIS is more accurate than RE in predicting loss of consciousness (LOC) during sevoflurane anesthesia (MD, .06; 95% confidence interval [CI], .02–.09; P = .009; I(2) = 92%). In contrast, there was no significant difference between BIS and RE for recovery of consciousness (ROC; MD, .01; 95% CI, .00–.02; P = .79; I(2) = 83%). Subgroup analyses revealed no significant differences in LOC (MD, .02; 95% CI, .01–.05; P = .13; I(2) = 60%) and ROC (MD, −.01; 95% CI, −.06–.04; P = .58; I(2) = 95%) in children. However, the results in adults demonstrated that BIS is more accurate than RE in predicting LOC (MD, −.07; 95% CI, .05–.10; P = .002; I(2) = 76%). LIMITATIONS: First, this meta-analysis was affected by a large study heterogeneity. Second, this analysis only included publications in English, therefore, some studies may have been omitted. CONCLUSION: BIS is more accurate than RE in predicting LOC during sevoflurane anesthesia in adults. However, no significant differences were identified in children. REGISTRATION NUMBER (PROSPERO): CRD42020163119