Closed-loop systems for automated hypnotic drug delivery during general anaesthesia: a systematic review and meta-analysis
Pooled result · ≈ additional 20 min of optimal anaesthetic depth during a 2 h procedureResult — go to the resultIncrease in time within target BIS range 17.6 % 95% CI 11.8–23.5Authors' conclusion
BIS-guided closed-loop systems achieve a bilateral safety profile in anaesthetic depth control, reducing deep anaesthesia without increasing light anaesthesia, with modestly faster recovery and preserved haemodynamic stability.
Study context
- Population
- Adults undergoing noncardiac surgery under GA
- Participants
- 1,898 adults · 17 RCTs
- Comparison
- BIS-guided closed-loop systems vs clinician-directed manual control
- Outcome
- Proportion of time within 10 BIS units of the target
Methodological detailsPROSPERO-registered, Searched PubMed, Embase, Cochrane CENTRAL, Web of Science through November 2025
- PROSPERO-registered
- Searched PubMed, Embase, Cochrane CENTRAL, Web of Science through November 2025
Pooled result
As reported in the abstract
≈ additional 20 min of optimal anaesthetic depth during a 2 h procedure
Increase in time within target BIS range
17.6 %
95% CI 11.8–23.5
P < 0.001
Closed-loop vs Manual control
increase in time within target BIS range 17.6 % (95% CI 11.8–23.5); P < 0.001
Further pooled results
Time with BIS <40
- Time with BIS <40 significantly reduced, MD
- −17.2% (95% CI −26.8 to −7.5; P<0.001)
Time with BIS >60
- Time with BIS >60 unchanged, MD
- −0.8% (95% CI −2.6 to 1.0; P=0.38)
Controller performance metrics (wobble, MDAPE, global score)
- Favoured automation (all P<0.001)
Time to extubation
- Shorter time to extubation, MD −1.68 min (P<0.001)
Propofol consumption
- No difference in propofol consumption (P=0.13)
Safety
- No difference in vasopressor use, RR 1.04 (P=0.62)
Original publication
Closed-loop systems for automated hypnotic drug delivery during general anaesthesia: a systematic review and meta-analysis. Br J Anaesth. Published 21 April 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →