Abstract
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 (POD(1,2,3,7)). Postoperative delirium was assessed with CAM (POD(1)-POD(3)), and cognitive function (MMSE) was measured preoperatively, POD(3), and POD(7). 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 (T(2)-T(5) and overall mean) (P<0.05). QoR-15 scores improved on POD(2) in Group B1 and on both POD(1) and POD(2) in Group B2 (P<0.05). The RCSQ scores increased on POD(1) and POD(3) in Group B1 (P<0.05) and on POD(1), POD(2) and POD(3) 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 POD(1) and POD(2) (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.