SA2 - Does Intraoperative Electroencephalogram Monitoring Use During Orthognathic Surgery Improve Anesthesia Emergence Time?

Oral Abstract Presenter(s)

• 

  Michael C. Britt, BS

  Dental Student
  Columbia University College of Dental Medicine
  Mineola, New York

Co-Author(s)

• VS

  Victoria Shen, BS

  Dental Student
  Harvard School of Dental Medicine
  Boston, Massachusetts
• 

  Mark A. Green, DDS, MD, FACS

  Assistant Professor
  Boston Children's Hospital
  Boston, Massachusetts

Abstract:
Statement of the Problem: Effective titration of anesthetics is critical for preventing intraoperative awareness or longer post-anesthesia recovery due to oversedation. Bispectral indexTM (Medtronic, Minneapolis, MN) and SedLine® (Masimo, Irvine, CA) monitoring both use proprietary algorithms to interpret a patient’s intraoperative electroencephalogram (EEG) and measure consciousness during general anesthesia. Both devices have been marketed as an asset to tailor drug delivery during general anesthesia to prevent oversedation and avoid delayed emergence from anesthesia.^1,2 This study aims to identify the effectiveness of EEG use in reducing the time needed to emerge from anesthesia following orthognathic surgery.
Materials and

Methods: This is a retrospective cohort study evaluating the association of EEG monitoring with emergence time from anesthesia following orthognathic procedures. This sample includes patients who underwent an orthognathic operation at Boston Children’s Hospital from January 1, 2023, to December 31, 2024. Hospital medical records were queried using Current Procedural Terminology (CPT) codes to identify patients who underwent a Le Fort I osteotomy (LFI), a bilateral sagittal split osteotomy (BSSO), or both (BiMax). The primary predictor variable was the use of a bispectral index (BISTM) or SedLine® monitoring device during the operation. The primary outcome variable was the time from the end of the procedure to extubation as reported in anesthesia records. Additional covariates included procedure type and length of procedure.
Methods of Data Analysis: Descriptive statistics were calculated. Chi-square, Fisher’s exact, and independent samples t-tests were utilized to assess associations between variables and outcomes. Results were considered statistically significant when P ≤ .05.
Results and Outcomes Data: A total of 209 patients underwent an orthognathic procedure during the study period (51.7% male, mean age of 19.98 ± 3.70 years). Procedures performed included Le Fort I (n = 92, 44%), BSSO (n = 29, 13.9%), and BiMax (n = 88, 42.1%). There were 40 subjects (19.1%) in the EEG monitoring group (19 with BISTM and 21 with SedLine®) and 169 subjects in the non-EEG monitoring group. Emergence from anesthesia was shorter without EEG monitoring, but not statistically significant between the two groups (EEG 21.35 ± 15.16 min vs no EEG 19.57 ± 13.30 min, P = .503). Procedure time did not vary significantly between the two groups, with shorter procedure length reported with EEG monitoring (EEG 156.28 ± 69.43 min vs. no EEG 163.11 ± 78.12 min, p=0.612). Procedure type (Le Fort I, BSSO, and BiMax) was associated with emergence time from anesthesia ( < 20 minutes vs 20-40 minutes vs >40 minutes, P = .012) with 79.5% of BSSO subjects having an emergence time of less than 20 minutes. Procedure length was not associated with changes in anesthesia emergence (P = .097).

Conclusions: The use of BISTM or SedLine® monitoring was not associated with any statistically significant changes on emergence from anesthesia duration. Procedure type, such as a BSSO, was more impactful on emergence time whereas overall operative time was not associated with changes. As most subjects underwent their orthognathic procedure without EEG monitoring (80.9%), additional experience with EEG monitoring during orthognathic surgery may help to further evaluate the influence of such monitoring devices on orthognathic surgery anesthesia emergence time, minimize unnecessary general anesthesia, and optimize operating room efficiency.

References
1. Bong CL, Balanza GA, Khoo CE, Tan JS, Desel T, Purdon PL. A Narrative Review Illustrating the Clinical Utility of Electroencephalogram-Guided Anesthesia Care in Children. Anesth Analg. 2023;137(1):108-123. doi:10.1213/ANE.0000000000006267.
2. Messieha ZS, Ananda RC, Hoffman WE, Punwani IC, Koenig HM. Bispectral Index System (BIS) monitoring reduces time to discharge in children requiring intramuscular sedation and general anesthesia for outpatient dental rehabilitation. Pediatr Dent. 2004;26(3):256-260.
Table 1. Bivariate Analysis of Use of EEG vs. Emergence from Anesthesia Time. Table 2. Bivariate Analysis of Covariates vs. Emergence from Anesthesia Time.