Luginbuhl 2003

Methods	RCT
Participants	Country: Switzerland N = 160 Sex: female Exclusion:central nervous system disease (i.e. history of cerebrovascular disease or epilepsy) or taking EEG‐affecting drug ans ASA > 3 Operation: gynaecological surgery lasted >15 min Desflurane subgroups ‐ASA: I/II/III 22/15/3, 15/22/3 ‐Gender: female ‐Age: 45.2±17.5, 47.1±17.8 years ‐Duration of anaesthesia: 100.5±58.2; 90.9±53.6 min Propofol subgroup (N = 80) ‐ASA: III/III 21/18/1, 22/16/2 ‐Gender: female ‐Age: 46.3±15.4, 48.7±15.7 years ‐Duration of anaesthesia: 100.5±58.2; 90.9±53.6 min
Interventions	Propofol guided by BIS (Aspect A‐2000‐2000 monitor, BIS version 3.3 , Aspect Medical Systems, Natick, MA), BIS target value between 45 and 55 during surgery, Cn = 40 Propofol using standard clinical guide (haemodynamic and vital signs criteria), Cn = 40 Desflurane guided by BIS (Aspect A‐2000 monitor, BIS version 3.3 , Aspect Medical Systems, Natick, MA), BIS target value between 45 and 55 during surgery, Cn = 40 Desflurane using standard clinical guide (haemodynamic vital signs criteria), Cn = 40
Outcomes	Mean propofol infusion rate (mg/kg/hr) Desflurane usage (age‐adjusted MAC‐hours) ‐Recovery profiles ‐Aldrete score ‐Global clinical impression score ‐Extubation time ‐Duration of PACU stay
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	"...the patients were randomized into four groups by drawing lots from sealed envelopes."
Allocation concealment (selection bias)	Low risk	"...the patients were randomized into four groups by drawing lots from sealed envelopes."
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Insufficient information regarding withdrawal or dropouts
Selective reporting (reporting bias)	Low risk	All expected outcome reported
Other bias	Unclear risk	The unblinded anaesthesiologists could potentially lead to 'learning contamination bias'
Blinding of patients?	Low risk	"The patients, the PACU nurses and the nurses on the ward were blinded to the allocation of the patients"
Blinding of anaesthesiologists?	High risk	"In the BIS group, the hypnotic drug concentration... was adjusted to keep the BIS between 45 and 55 during surgery" This indicates no blinding of the anaesthesia care providers
Blinding of outcome assessors?	Low risk	"The patients, the PACU nurses and the nurses on the ward were blinded to the allocation of the patients."