Bispectral Index Monitoring (BIS) is an objective measure of brain activity. It assists clinicians in the precise titration of anesthetic drugs, leading to reduced use of hypnotic medications and improved recovery times. We aimed to evaluate the effect of Bispectral Index (BIS) monitoring in addition to standard monitoring on the dose of propofol used. 

We performed a systematic review across MEDLINE and Cochrane Central Register for all types of trials from 01/01/2019 until 31/12/2024, evaluating the effect of Bispectral Index (BIS) monitoring in addition to standard monitoring on propofol dose. The primary outcome was the total propofol dose. We performed pairwise analyses and we present the effect size on study outcomes as Mean Difference (MD) with 95% confidence interval (CI). The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Three RCTs and two cohort studies with 947 subjects were included. Compared to standard monitoring, the addition of BIS significantly reduced the total propofol used in each procedure [MD -0.25 95% CI (-0.25, -0.47), I²=61%]. Contrariwise, use of BIS did not have a similar effect on mean propofol dose [MD -0.41 95% CI (-0.41, -1.37), I²=61%]; the certainty of evidence was very low. 

Addition of BIS to standard monitoring during sedated GI endoscopy significantly reduces the total propofol dose.