{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T02:12:36Z","timestamp":1772849556135,"version":"3.50.1"},"reference-count":41,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T00:00:00Z","timestamp":1763769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The bispectral index (BIS) represents a promising tool for monitoring the depth of hypnosis. However, its utility in guiding sevoflurane administration during general anesthesia in pediatric patients is not well known.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We performed a systematic review and meta\u2010analysis of randomized controlled trials comparing BIS\u2010guided versus standard practice sevoflurane administration in pediatric patients. PubMed\/MEDLINE, Embase, and the Cochrane Central Register of Clinical Trials were searched for trials published up to May 2025. Analyses were conducted using RevMan 5.4.1., and heterogeneity was assessed using the I\n                      <jats:sup>2<\/jats:sup>\n                      statistic.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included nine studies randomizing a total of 730 pediatric patients, of whom 359 (49.2%) were managed with BIS monitoring. BIS\u2010guided anesthesia was associated with significantly lower mean end\u2010tidal sevoflurane concentrations, both during the maintenance phase (MD \u22120.46; 95% CI: \u22120.62 to \u22120.29;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.00001) and at the end of surgery (MD \u22120.31; 95% CI:\u00a0\u22120.47 to \u22120.14;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0003). Furthermore, the BIS\u2010guided group experienced a shorter time to airway removal (MD \u22121.69\u2009min; 95% CI: \u22122.84 to \u22120.55\u2009min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004) and a shorter time to post\u2010anesthesia care unit discharge (MD \u221211.82\u2009min; 95% CI: \u221217.80 to \u22125.84\u2009min;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0001). No significant difference was observed in Pediatric Anesthesia Emergence Delirium score between groups (MD \u22120.35; 95% CI: \u22121.90 to 1.19;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.65).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>BIS\u2010guided monitoring offers a strategy to reduce end\u2010tidal sevoflurane concentrations, shortening time to airway removal and post\u2010anesthesia care unit discharge in pediatric patients undergoing sevoflurane anesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Registration<\/jats:title>\n                    <jats:p>PROSPERO, review no. CRD420251067409<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/pan.70080","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T08:59:52Z","timestamp":1763801992000},"page":"164-172","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy of Bispectral Index\u2010Guided Sevoflurane Administration in Pediatric Patients Undergoing General Anesthesia: An up\u2010To\u2010Date Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8365-1230","authenticated-orcid":false,"given":"Kamil","family":"Derylo","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9993-0724","authenticated-orcid":false,"given":"Nethra","family":"Sannasi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences University of Bologna  Bologna Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-9690-4081","authenticated-orcid":false,"given":"Meisya","family":"Rosamystica","sequence":"additional","affiliation":[{"name":"David Tvildiani Medical University  Tbilisi Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4831-9526","authenticated-orcid":false,"given":"Eros","family":"Pilia","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care G. Brotzu Hospital  Cagliari Italy"},{"name":"Department of Medical Science and Public Health University of Cagliari  Cagliari Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,22]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40140\u2010022\u201000540\u20102"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neubiorev.2006.06.001"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/aln.0000000000004116"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.2165\/00128072\u2010199901020\u201000005"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2021.01.024"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1548376"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.18103\/mra.v8i4.2057"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.12168"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542\u2010199704000\u201000014"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539\u2010199704000\u201000035"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15785"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542\u2010200011000\u201000029"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/bf03018310"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_16_1","unstructured":"Handbooks and Manuals \u201cCochrane Handbook for Systematic Reviews of Interventions \u201d(2025) https:\/\/training.cochrane.org\/handbook."},{"key":"e_1_2_12_17_1","unstructured":"Medtronic \u201cBIS Pediatric Sensor \u201d(2025) https:\/\/www.medtronic.com\/en\u2010us\/healthcare\u2010professionals\/products\/patient\u2010monitoring\/brain\u2010monitoring\/brain\u2010sensors\/bis\u2010pediatric\u2010sensor.html."},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_12_19_1","unstructured":"P.Luo \u201cOnlinemeta \u201d(2025) https:\/\/smuonco.shinyapps.io\/Onlinemeta\/."},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/11101849.2020.1838750"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539\u2010200104000\u201000015"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2023.101318"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcma.2011.01.004"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12692"},{"issue":"3","key":"e_1_2_12_25_1","first-page":"256","article-title":"Bispectral Index System (BIS) Monitoring Reduces Time to Discharge in Children Requiring Intramuscular Sedation and General Anesthesia for Outpatient Dental Rehabilitation","volume":"26","author":"Messieha Z. 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