Article Notes
Article pearls, summaries and comments.
The flaw with many closed loop TIVA-BIS studies, such as this one, is that they unquestionably assume reliability of BIS and are not powered for important morbidity or mortality outcomes.
This study while professing to show 'superiority' of a closed-loop system, really just shows that when given a monitor target the algorithm can more accurately and rapidly adjust the TIVA to maintain this. This may well be a good outcome, but does not necessarily equate to 'good' or safe anesthesia.
It's important to note that BIS has been validated essentially as an awareness alarm, not (yet) as a guide to appropriate depth of anesthesia.