Cochrane Review 2016

“There is moderate quality evidence that BIS guided anaesthesia reduces the incidence of post operative delirium compared to clinical judgement”

CODA trial 2012

  • Randomised control trial comparing BIS guided to clinical judgement
  • The primary outcome was post-operative cognitive dysfunction (POCD) at 3 months post-op
  • BIS group – anaesthetic adjusted to achieve BIS 40-60
  • 21% decrease in propofol delivery and 30% decrease in volatile in BIS group
  • BIS group also reduced risk of postoperative delirium during initial hospitalization by 35% and POCD at 3 months by 31%
  • BIS group recovered from anaesthesia more quickly with earlier eye opening and faster discharge from PACU

BJA 2013 (Radtke et al)

  • Very similar trial to above – BIS guided vs clinical judgement
  • Similar decrease in post operative delirium but no difference in POCD


  • Moderate quality evidence that use of BIS decreases post operative delirium but less clear are its effect on post operative cognitive dysfunction.