{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T20:42:07Z","timestamp":1790109727344,"version":"4.0.1"},"reference-count":20,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T00:00:00Z","timestamp":1735948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016304","name":"Medtronic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016304","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In pediatric patients, the use of processed EEG monitoring may reduce the amount of anesthesia administered while maintaining adequate depth of anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The primary aim of this study was to evaluate whether use of a BIS monitor to guide sevoflurane administration might reduce the average end tidal sevoflurane concentration used in children 4\u201318\u2009years of age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants in three age groups (4\u20138, 9\u201312, and 13\u201318\u2009years) were randomized to either the BIS guided group or the control group. Use of sevoflurane as the primary maintenance anesthetic was the only requirement in both arms. In the BIS guided group, sevoflurane was titrated to achieve a target BIS value of 45\u201360 during the maintenance period. In the control arm, clinicians were blinded to the BIS value. Primary outcome was mean end\u2010tidal sevoflurane concentration during maintenance phase of anesthesia. Secondary assessments included time to discharge and\u00a0the readiness and quality of recovery as assessed by the Pediatric Anesthesia Emergence Delirium scale, the modified Aldrete Score, and the Wong\u2013Baker FACES scale. An intention\u2010to\u2010treat analysis was used to analyze and compare groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 180 participants were randomized. Following randomization, 10 participants did not undergo any study procedures, leaving 84 participants in the BIS guided group and 86 participants in the control group. Across all age groups, the average end\u2010tidal sevoflurane concentration was less in the BIS guided group compared to control (4\u20138\u2009years: 2.2%\u2009\u00b1\u20090.3% vs. 2.4%\u2009\u00b1\u20090.4%, \u22120.3% [\u22120.4%, \u22120.1%]; 9\u201312\u2009years: 1.7%\u2009\u00b1\u20090.5% vs. 2.1%\u2009\u00b1\u20090.6%, \u22120.4% [\u22120.7%, \u22120.1%]; 13\u201318\u2009years: 1.6%\u2009\u00b1\u20090.4% vs. 1.9%\u2009\u00b1\u20090.5%, \u22120.3% [\u22120.5%, \u22120.1%]). No differences in recovery outcomes between treatment groups were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In pediatric participants, the BIS guided group reported a lower average end\u2010tidal sevoflurane concentration compared to control, though no significant differences in recovery profile were noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>The Bispectral Index (BIS) is a processed EEG tool that can be used to titrate general anesthesia to achieve desired anesthetic depth. Brain monitoring with BIS resulted in lower average end\u2010tidal sevoflurane concentrations in children aged 4\u201318\u2009years undergoing general anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/www.ClinicalTrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT04810481\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.15057","type":"journal-article","created":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T04:54:49Z","timestamp":1735966489000},"page":"277-286","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["<scp>BIS<\/scp>\n                    Guided Titration of Sevoflurane in Pediatric Patients Undergoing Elective Surgery: A Randomized Controlled Trial"],"prefix":"10.1111","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7665-8138","authenticated-orcid":false,"given":"T. Wesley","family":"Templeton","sequence":"first","affiliation":[{"name":"Department of Anesthesiology Wake Forest University School of Medicine  Winston\u2010Salem North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gijo","family":"Alex","sequence":"additional","affiliation":[{"name":"UT Southwestern Medical Center Children's Health Dallas  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean D.","family":"Eloy","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Rutgers New Jersey Medical School  Newark New Jersey USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay","family":"Stollings","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Ing","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1471-359X","authenticated-orcid":false,"given":"Eric C.","family":"Cheon","sequence":"additional","affiliation":[{"name":"Department of Pediatric Anesthesiology Ann and Robert H Lurie Children's Hospital of Chicago  Chicago Illinois USA"},{"name":"Northwestern University Feinberg School of Medicine  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Belani","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology M Health Fairview, Masonic Children's Hospital, University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilan","family":"Breskin","sequence":"additional","affiliation":[{"name":"Research and Development Acute Care &amp; Monitoring, Medtronic  Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Sebel","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9985-8637","authenticated-orcid":false,"given":"Brad M.","family":"Taicher","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Duke University School of Medicine, Duke University Medical Center  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the BTiger Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,4]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004116"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2021.01.024"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.18103\/mra.v8i4.2057"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12168"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci12091195"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13365"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-199704000-00035"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-199704000-00014"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13101789"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15785"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.4103\/0976-500X.72352"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200104000-00015"},{"key":"e_1_2_11_14_1","volume-title":"StatPearls","author":"Ding D.","year":"2023"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006267"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12890"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13579"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2009.03240.x"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-200004000-00018"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13086"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.7326\/M22-1460"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.15057","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T13:00:36Z","timestamp":1741438836000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.15057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,4]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["10.1111\/pan.15057"],"URL":"https:\/\/doi.org\/10.1111\/pan.15057","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,4]]},"assertion":[{"value":"2024-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-04","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}