Sevoflurane titration using bispectral index decreases postoperative vomiting in phase II recovery after ambulatory surgery

We tested the hypothesis that titration of sevoflurane using bispectral index (BIS) of the electroencephalogram decreases postoperative nausea and vomiting and improves recovery after outpatient gynecologic laparoscopy. After propofol induction, anesthesia was maintained in all patients with sevoflurane in 65% nitrous oxide and oxygen. In the BIS-Titrated group (n = 32), sevoflurane was titrated to maintain the BIS between 50 and 60 during surgery. In the Control group (n = 30), sevoflurane was adjusted to keep hemodynamic variables within 25% of control values. The severity of pain, postoperative nausea and vomiting, and recovery variables were recorded. In the Control group, 30% of the patients had BIS < 40 during surgery (versus 0 in the BIS-Titrated group). Orientation and ability to drink were achieved earlier in the BIS group (P < 0.05). At 30 min after cessation of nitrous oxide, patients in the BIS group performed better in the psychomotor recovery test (P < 0.01). In Phase II recovery room, these patients had significantly less vomiting than the patients in the Control group (16% versus 40% of the patients, respectively, P < 0.05). No differences were found in times to achieve home readiness.