Individualized intraoperative BIS targeting based on preoperative BIS values in the awake state: a review and strategy prospect for preventing postoperative delirium in older patients.

Authors

Jialin Zhao, Shiqi Jiang

Published in

Minerva anestesiologica. Volume 92. Issue 10. Pages 1006-1015.

Abstract

Postoperative delirium (POD) is a frequent and serious complication in older surgical patients and is associated with adverse short- and long-term outcomes. Bispectral Index (BIS) monitoring is widely used to guide intraoperative depth of anesthesia. However, the conventional strategy of maintaining a uniform BIS target range may not adequately account for interindividual differences in preoperative brain function, particularly in older adults with reduced neural reserve. This narrative review integrates evidence from three complementary domains: 1) clinical studies evaluating the association between preoperative resting BIS values in the awake state and the risk of POD; 2) mechanistic and clinical evidence linking excessive anesthetic depth, particularly electroencephalographic burst suppression, to POD; 3) interventional trials assessing the effect of intraoperative BIS-guided anesthesia management on delirium outcomes. Accumulating evidence indicates that a lower preoperative resting BIS value in the awake state is potentially independently associated with an increased risk of POD in older patients. Intraoperative BIS-guided anesthesia has been shown to reduce exposure to deep anesthesia and EEG burst suppression, which are consistently linked to higher delirium incidence. These findings suggest that patients with preoperatively identified brain vulnerability may benefit from higher individualized intraoperative BIS targets, rather than a fixed universal range. Integrating preoperative resting BIS assessment into perioperative anesthesia management may enable risk stratification and support individualized regulation of anesthetic depth in older adults. When incorporated into a multimodal delirium prevention framework, this individualized approach may offer a rational pathway toward improved delirium prevention and perioperative neuroprotection in older adults, warranting validation in future prospective randomized studies.

PMID:
42949504
Bibliographic data and abstract were imported from PubMed on 28 Oct 2026.

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