The effect of BIS-guided sevoflurane anesthesia on postoperative nausea and vomiting in pediatric adenoidectomy: a prospective randomized controlled trial.

BACKGROUND: Postoperative nausea and vomiting (PONV) is a frequent complication in pediatric patients undergoing adenoidectomy. Bispectral index (BIS) monitoring, an electroencephalography-based method for assessing anesthetic depth, enables individualized sevoflurane titration and may reduce unnecessary exposure to volatile anesthetics. OBJECTIVES: To determine whether BIS-guided sevoflurane anesthesia reduces PONV in children undergoing adenoidectomy. DESIGN AND SETTING: Single-center, prospective, randomized, assessor-blinded trial conducted at University of Health Sciences, Kocaeli City Hospital, Kocaeli, Türkiye. METHODS: Fifty-eight children aged 3-8 years (American Society of Anesthesiologists score I-II) undergoing elective adenoidectomy were randomized to BIS-guided anesthesia (n = 29) or standard care (n = 29). Both groups received sevoflurane anesthesia. The primary outcome was PONV within the first 24 postoperative hours. Secondary outcomes were emergence time, total sevoflurane consumption, remifentanil dose, and rescue antiemetic use. RESULTS: PONV within 24 hours occurred less frequently in the BIS-guided group than in controls (p = 0.015), with the greatest between-group differences observed at 0-1 hour and 1-6 hours. Sevoflurane consumption and emergence time were lower in the BIS-guided group (p < 0.05). BIS-guided anesthesia was independently associated with lower odds of PONV (OR = 0.212; 95% CI: 0.067-0.675; p = 0.009). CONCLUSIONS: BIS monitoring may be a useful strategy for optimizing anesthetic depth and reducing early PONV in pediatric patients. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT07189845). Available at: https://clinicaltrials.gov/study/NCT07189845.