The Effect of Bispectral Index Monitoring on Emergence Delirium in Pediatric Patients: A Retrospective Observational Study

Aim: Emergence delirium (ED) is a common behavioral disturbance during recovery from general anesthesia in pediatric patients. This retrospective observational study aimed to evaluate the effect of intraoperative bispectral index (BIS) monitoring on the incidence and severity of ED in children undergoing elective surgery.Material and Methods: Medical records of 160 pediatric patients aged 2-7 years who underwent elective surgery under general anesthesia were retrospectively reviewed. Patients were divided into two groups according to anesthetic depth monitoring: BIS-guided (n=80) and control (n=80). ED was assessed using the pediatric anesthesia emergence delirium (PAED) scale, and postoperative pain was evaluated using the face, legs, activity, cry, consolability (FLACC) scale.Results: The rate of ED was significantly lower in the BIS group compared with the control group (4 patients [5.0%] vs. 54 patients [67.5%], p=0.001). PAED (4.00±2.1 vs. 7.17±2.9) and FLACC (2.11±1.5 vs. 3.00±1.7) scores were also significantly reduced in the BIS-monitored group (p=0.001 for both). Recovery time (8.52±2.9 vs. 10.04±3.2 minutes, p=0.001) and PACU stay duration (44.68±11.2 vs. 59.76±14.5 minutes, p=0.001) were significantly shorter in the BIS group. In multivariate logistic regression analysis, BIS monitoring remained an independent protective factor against ED (OR=0.020, 95% CI: 0.010-0.080, p=0.001).Conclusion: Intraoperative BIS monitoring significantly reduces ED and improves recovery quality in pediatric patients. Objective monitoring of anesthetic depth may improve postoperative behavioral stability.