{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:43:04Z","timestamp":1787071384301,"version":"build-2736575974"},"reference-count":13,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T00:00:00Z","timestamp":1757635200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>For facial nerve monitoring during parotidectomy, neuromuscular blockers should be avoided. Assessment of depth of anesthesia based on clinical signs or end-tidal anesthetic gas concentration is unreliable. We compared intraoperative dexmedetomidine requirement with and without bispectral index (BIS) monitoring in patients undergoing total parotidectomy under general anesthesia (GA) without muscle relaxants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>This was a prospective, randomized study conducted in 60 patients undergoing total parotidectomy under GA with nerve conduction studies. Following induction and intubation, all patients received dexmedetomidine 1 \u00b5g\/kg bolus. In Group A, BIS values were continuously monitored. Following initial bolus, only when the BIS value was &gt;50, dexmedetomidine infusion was restarted at 0.5 \u00b5g\/kg\/h and adjusted to maintain BIS between 40 and 50. In Group B, dexmedetomidine 1 \u00b5g\/kg bolus was given, followed by 0.5 \u00b5g\/kg\/h initially and infusion. Infusion rate was titrated based on hemodynamic variables and patient immobility. If patients in any group moved intraoperatively, propofol 0.5 mg\/kg, not &gt;30 mg, was given, and dose of dexmedetomidine infusion was increased by 0.1 \u00b5g\/kg\/h increments to a maximum dose of 0.7 \u00b5g\/kg\/h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Rate of dexmedetomidine infusion was significantly lower in Group A compared to Group B (0.058 \u00b1 0.011 vs. 0.547 \u00b1 0.133 \u00b5g\/kg\/h). Extubation time was significantly lower in Group A (14.40 \u00b1 8.845 vs. 30.27 \u00b1 9.903 min). Hemodynamic responses, sevoflurane and propofol consumption, incidence of intraoperative patient immobility, hypotension, and use of vasopressors were comparable in both groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Use of BIS monitoring in patients undergoing total parotidectomy under GA without muscle relaxants resulted in significant reduction in intraoperative dexmedetomidine consumption with significantly shorter extubation time.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_580_24","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T09:00:19Z","timestamp":1757667619000},"page":"671-677","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Impact of bispectral index monitoring on dose requirement of dexmedetomidine during total parotidectomy under general anesthesia without muscle relaxants"],"prefix":"10.4103","volume":"41","author":[{"given":"Sunil","family":"Rajan","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maharnab","family":"Bhuyan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayathri","family":"Sreekumar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Madhu","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lokeshshiva","family":"Arul","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roniya Ann","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"key":"R1-20251001","doi-asserted-by":"crossref","first-page":"193","DOI":"10.4103\/0970-9185.209752","article-title":"Effectiveness of transtracheal lidocaine as an adjunct to general anesthesia in providing patient immobility during total parotidectomy: A comparison with dexmedetomidine infusion","volume":"33","author":"Rajan","year":"2017","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R2-20251001","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1213\/ANE.0000000000003470","article-title":"The effect of dexmedetomidine on propofol requirements during anesthesia administered by bispectral index-guided closed-loop anesthesia delivery system: A randomized controlled study","volume":"129","author":"Dutta","year":"2019","journal-title":"Anesth Analg"},{"key":"R3-20251001","first-page":"334","article-title":"Bispectral index-guided comparison of dexmedetomidine and fentanyl as an adjuvant with propofol to achieve an adequate depth for endotracheal intubation-A double-blind randomised controlled trial","volume":"68","author":"Choudhary","year":"2024","journal-title":"Indian J Anaesth"},{"key":"R4-20251001","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1590\/S0034-70942004000300003","article-title":"[Relationship between dexmedetomidine continuous infusion and end-tidal sevoflurane concentration, monitored by bispectral analysis.]","volume":"54","author":"Magalh\u00e3es","year":"2004","journal-title":"Rev Bras Anestesiol"},{"key":"R5-20251001","first-page":"855","article-title":"[Impact of dexmedetomidine-sevoflurane anesthesia on intraoperative wake-up test in children patients undergoing scoliosis surgery]","volume":"48","author":"Quan","year":"2016","journal-title":"Beijing Da Xue Xue Bao Yi Xue Ban"},{"key":"R6-20251001","first-page":"133","article-title":"Influence of dexmedetomidine upon sevoflurane end-expiratory concentration. Evaluation by bispectral index, suppression rate and electroencephalographic power spectral analysis","volume":"52","author":"Nunes","year":"2002","journal-title":"Rev Bras Anestesiol"},{"key":"R7-20251001","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4103\/roaic.roaic_86_17","article-title":"The effects of dexmedetomidine on the bispectral index during cesarean section under general anesthesia with low-isoflurane anesthesia","volume":"6","author":"Abd","year":"2019","journal-title":"Res Opin Anesth Intensive Care"},{"key":"R8-20251001","first-page":"e24930","article-title":"Anesthetic stability of propofol, dexmedetomidine, and isoflurane by measuring Bispectral Index (BIS) and hemodynamic indices: A comparative study","volume":"14","author":"Kumar","year":"2022","journal-title":"Cureus"},{"key":"R10-20251001","doi-asserted-by":"crossref","first-page":"199","DOI":"10.4103\/0970-9185.130016","article-title":"Transtracheal lidocaine: An alternative to intraoperative propofol infusion when muscle relaxants are not used","volume":"30","author":"Rajan","year":"2014","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R11-20251001","doi-asserted-by":"crossref","first-page":"683","DOI":"10.4103\/aer.AER_134_19","article-title":"Safety and efficacy of dexmedetomidine versus propofol infusion as an adjunct to transtracheal block in ensuring patient immobility during general anesthesia without the use of muscle relaxants","volume":"13","author":"Tosh","year":"2019","journal-title":"Anesth Essays Res"},{"key":"R12-20251001","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4103\/0259-1162.94750","article-title":"Current role of dexmedetomidine in clinical anesthesia and intensive care","volume":"5","author":"Kaur","year":"2011","journal-title":"Anesth Essays Res"},{"key":"R13-20251001","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.bja.2023.06.042","article-title":"Impact of female sex on anaesthetic awareness, depth, and emergence: A systematic review and meta-analysis","volume":"131","author":"Braithwaite","year":"2023","journal-title":"Br J Anaesth"},{"key":"R14-20251001","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.chest.2016.12.002","article-title":"Control of ventilation in health and disease","volume":"151","author":"Chowdhuri","year":"2017","journal-title":"Chest"}],"container-title":["Journal of Anaesthesiology Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_580_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:45:19Z","timestamp":1787067919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_580_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":13,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/joacp.joacp_580_24","relation":{},"ISSN":["0970-9185","2231-2730"],"issn-type":[{"value":"0970-9185","type":"print"},{"value":"2231-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]},"assertion":[{"value":"2024-11-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-24","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}