The Impact of BIS-Monitored Depth Regulation on Prognosis: Improving Outcomes for Patients with Chronic DoCs

Abstract Background: The value of the bispectral index (BIS) for monitoring anesthesia in patients with disorder of consciousness (DoC) has not yet been determined. Objective: To investigate the effect of BIS-monitored depth regulation on the prognosis of patients with chronic DoCs undergoing spinal cord stimulation (SCS) implantation. Methods: Ninety-two 92 patients with DoC who underwent SCS implantation under general anesthesia were followed up for three months after surgery. Among the cohort, 83 patients met the inclusion criteria and were divided into the BIS (n = 45) and non-BIS (n = 38) groups. Relevant information was collected, along with patient characteristics. Coma recovery scale-revised (CRS-R) scores and outcomes were assessed preoperatively and three months postoperatively (CRS-R3m). Results: In the BIS group, the CRS-R3m score was higher than the preoperative CRS-R score; however, in the non-BIS group, there was no significant difference between the scores. The CRS-R3m score in the BIS group was higher than that in the non-BIS group. Consciousness improvement was evaluated in a multifactor logistic regression analysis, which revealed that dexmedetomidine was a high-risk factor for consciousness improvement. During follow-up, two patients in the BIS group experienced a decrease in consciousness, while two patients in the non-BIS group died. Conclusion: For patients with DoC undergoing SCS implantation under general anesthesia, intraoperative BIS monitoring to control the depth of general anesthesia sedation contributes to better postoperative outcomes. It is advisable to avoid the use of dexmedetomidine during the perioperative period, because it affects patient outcomes.