skip to main content

Correlation Between Electroencephalography-Based Sedation Indices (BIS and qCON) and Mean Arterial Pressure (MAP) in Sedated Postoperative Patients in the Intensive Care Unit

1Faculty of Medicine, Universitas Sumatera Utara/Adam Malik Hospital, Medan, Indonesia

2Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia

Received: 3 Apr 2026; Revised: 7 Jul 2026; Accepted: 2 Nov 2026; Available online: 2 Nov 2026.
Open Access Copyright 2026 JAI (Jurnal Anestesiologi Indonesia)
Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.

Citation Format:
Cover Image
Abstract

: To evaluate the correlation between BIS and qCON with MAP in sedated postoperative patients upon ICU admission.

Methods: This analytical observational study with a cross-sectional design included 38 postoperative patients admitted to the ICU. All patients received a standardized sedative-analgesic regimen of midazolam and fentanyl. Sedation depth was assessed using BIS and qCON obtained from the CONOX® monitor sequentially, while MAP was measured 10 minutes after sedation was administered. Data were analyzed using Spearman’s correlation test, with a p-value < 0.05 considered statistically significant.

Results: The median BIS and qCON values were 61 (59–71) and 60 (59–70), respectively, indicating moderate sedation. The mean MAP was 90.9 ± 10.2 mmHg. BIS showed a moderate positive correlation with MAP (ρ = 0.481, p = 0.017), with an R² of 0.231, while qCON also demonstrated a moderate positive correlation with MAP (ρ = 0.433, p = 0.022), with an R² of 0.187. These findings indicate that higher sedation index values, reflecting lighter sedation, were associated with higher MAP.

Conclusion: BIS and qCON are moderately correlated with MAP in sedated postoperative ICU patients, indicating an association between sedation depth and sympathetic activity. However, the modest strength of this relationship suggests that MAP is influenced by multiple factors beyond sedation depth.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
Copyright Transfer Agreement
Subject
Type Other
  Download (458KB)    Indexing metadata
 common.other
Ethical Clearance
Subject
Type Other
  Download (1MB)    Indexing metadata
Email colleagues
Keywords: BIS; ICU; mean arterial pressure; postoperative; qCON; sedation

Article Metrics:

  1. Boncyk C, Rolfsen ML, Richards D, Stollings JL, Mart MF, Hughes CG, Ely EW. Management of pain and sedation in the intensive care unit. bmj. 2024 Dec 9;387
  2. Nordness MF, Hayhurst CJ, Pandharipande P. Current Perspectives on the Assessment and Management of Pain in the Intensive Care Unit. J Pain Res. 2021 Jun 14;14:1733-1744. doi: 10.2147/JPR.S256406.PMID:34163231;PMCID:PMC8214553
  3. Pan S, Wu Y. Application of the BIS in the ICU. In: Multi-Modal EEG Monitoring of Severely Neurologically Ill Patients 2021 Oct 24 (pp. 335-345). Singapore: Springer Singapore
  4. Stewart JA, Särkelä MOK, Wennervirta J, Vakkuri AP. Novel insights on association and reactivity of Bispectral Index, frontal electromyogram, and autonomic responses in nociception-sedation monitoring of critical care patients. BMC Anesthesiol. 2022 Nov 15;22(1):353. doi: 10.1186/s12871-022-01864-6.PMID:36380289;PMCID:PMC9664663
  5. Hu Q, Liu X, Xiang Y, Lei X, Yu H, Liu L, Feng J. Comparing different postoperative sedation strategies for patients in the intensive care unit after cardiac surgery: A systematic review of randomized controlled trials and network meta-analysis. Basic Clin Pharmacol Toxicol. 2024 Aug;135(2):180-194. doi: 10.1111/bcpt.14043.Epub2024Jun21.PMID:39004790
  6. Heybati K, Xie G, Deng J, Walkey AJ, Gajic O, Yadav H. Hemodynamic Effects of Guideline-Based Sedation in Mechanically Ventilated Adults: A Multicenter Observational Analysis. Crit Care Explor. 2025 Sep 5;7(9):e1313. doi: 10.1097/CCE.0000000000001313.PMID:40911767;PMCID:PMC12416995
  7. Froese L, Dian J, Gomez A, Batson C, Sainbhi AS, Zeiler FA. Association Between Processed Electroencephalogram-Based Objectively Measured Depth of Sedation and Cerebrovascular Response: A Systematic Scoping Overview of the Human and Animal Literature. Front Neurol. 2021 Aug 16;12:692207. doi: 10.3389/fneur.2021.692207.PMID:34484100;PMCID:PMC8415224
  8. Liu X, Nakano M, Yamaguchi A, Bush B, Akiyoshi K, Lee JK, Koehler RC, Hogue CW, Brown CH 4th. The association of bispectral index values and metrics of cerebral perfusion during cardiopulmonary bypass. J Clin Anesth. 2021 Nov;74:110395. doi: 10.1016/j.jclinane.2021.110395.Epub2021Jun17.PMID:34147015;PMCID:PMC8530850
  9. Sherazi MZ, Kadiman S, Sulaiman S. Integrating BIS and cerebral oximetry in anesthesia: a narrative review on advanced monitoring for cardiac surgery. Anesthesiology and Perioperative Science. 2026 Feb 4;4(1):13
  10. Rasulo FA, Hopkins P, Lobo FA, Pandin P, Matta B, Carozzi C, Romagnoli S, Absalom A, Badenes R, Bleck T, Caricato A. Processed electroencephalogram-based monitoring to guide sedation in critically ill adult patients: recommendations from an international expert panel-based consensus. Neurocritical care. 2023 Apr;38(2):296-311
  11. Lewis K, Balas MC, Stollings JL, et al. A focused update to the clinical practice guidelines for the prevention and management of pain, anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med. 2025 Mar;53(3):e711-e727
  12. Huespe I, Giunta D, Acosta K, Avila D, Prado E, Sanghavi D, Bisso IC, Giannasi S, Carini FC. Comparing Bispectral Index Monitoring vs Clinical Assessment for Deep Sedation in the ICU: Effects on Delirium Reduction and Sedative Drug Doses-A Randomized Trial. Chest. 2024 Oct;166(4):733-742. doi: 10.1016/j.chest.2024.05.031.Epub2024Jun18.PMID:38901489
  13. Oh A, Karim N, Pitt A, Hodgetts S, Edwards DW, Mullan D, Laasch HU. EEG bispectral index sensor guidance improves accuracy and safety of procedural sedation. Clinical radiology. 2024 Dec 1;79(12):e1490-6
  14. Heavner MS, Gorman EF, Linn DD, Yeung SYA, Miano TA. Systematic review and meta-analysis of the correlation between bispectral index (BIS) and clinical sedation scales: Toward defining the role of BIS in critically ill patients. Pharmacotherapy. 2022 Aug;42(8):667-676. doi: 10.1002/phar.2712.Epub2022Jun30.PMID:35707961;PMCID:PMC9671609
  15. Kaye C, Rhodes J, Austin P, Casey M, Gould R, Sira J, Treweek S, MacLennan G. Assessment of depth of sedation using Bispectral Index™ monitoring in patients with severe traumatic brain injury in UK intensive care units. BJA open. 2024 Jun 1;10:100287
  16. White KC, Quick L, Durkin Z, McCullough J, Laupland KB, Blank S, Attokaran AG, Kumar A, Shekar K, Garrett P, Meyer J, Tabah A, Ramanan M, Luke S, Chaba A, Bellomo R, Lamontagne F, Young PJ; Queensland Critical Care Research Network (QCCRN). Mean arterial pressure in critically ill adults receiving vasopressors: A multicentre, observational study. Crit Care Resusc. 2025 Mar 13;27(1):100103. doi: 10.1016/j.ccrj.2025.100103.PMID:40143833;PMCID:PMC11938056
  17. Dunham M, Ransom KJ, McAuley CE, Gruber BS, Mangalat D, Flowers LL. Severe brain injury ICU outcomes are associated with Cranial-Arterial Pressure Index and noninvasive Bispectral Index and transcranial oxygen saturation: a prospective, preliminary study. Critical Care. 2006 Nov 14;10(6):R159
  18. Manning J, Chiasson M. Does Bispectral Index Monitoring Belong in the Intensive Care Unit Setting?: A Narrative Review of Evidence. Dimensions of Critical Care Nursing. 2025 Sep 1;44(5):231-8
  19. Schnetz MP, Reon BJ, Ibinson JW, Kaynar M, Mahajan A, Vogt KM. Bispectral Index Changes Following Boluses of Commonly Used Intravenous Medications During Volatile Anesthesia Identified From Retrospective Data. Anesth Analg. 2024 Mar 1;138(3):635-644. doi: 10.1213/ANE.0000000000006633.Epub2023Aug15.PMID:37582055;PMCID:PMC10867275
  20. Harsha MS, Bhatia PK, Sharma A, Sethi P. Comparison of Quantium Consciousness Index and Richmond Agitation Sedation Scale in Mechanically Ventilated Critically Ill Patients: An Observational Study. Indian J Crit Care Med. 2022 Summer;26(4):491-495. doi: 10.5005/jp-journals-10071-24183.PMID:35656063;PMCID:PMC9067479
  21. Elvir-Lazo OL, Yumul R, Wang R, Fejleh A, Hager J, White PF. Comparison of the qNOX, qCON and Bispectral (BIS) index responses to noxious stimuli during surgery. Journal of Surgery and Research. 2025;8:49-57

Last update:

No citation recorded.

Last update: 2026-11-07 03:17:10

No citation recorded.