Recart 2003

Methods	RCT
Participants	Country: USA N = 90 ASA: NA Gender: Male/Female 21/9, 20/10, 24/6 Age: 47±17,46±15,42±14 Exclusion: history of CNS disease, chronic use of psychoactive medication, and clinical significant cardiovascular, renal, hepatic or endocrinology disorders Operation: laparoscopic general surgery procedures (cholecystectomy, gastric bypass/banding, hernia repair) Duration of anaesthesia: 125±52; 127±38 min
Interventions	Desflurane guided by BIS (BIS TM sensor XP, Aspect Medical Systems, Newton, MA) for maintaining BIS values of 45‐55 Desflurane guided by clinical signs Desflurane guided by auditory evoked potential index (AAI)
Outcomes	‐End tidal concentrations of desflurane (%) (main outcome) ‐Total fentanyl used ‐Total rocuronium used (mg) ‐ Requirement of labetalol (Cn,%) ‐Time to open eyes ‐Time to obey simple verbal commands ‐Time to orientation ‐Time to be extubated ‐Time to achieve White fast‐track score ≥12 ‐Time to achieve Aldrete discharge score of 10 ‐Length of stay in the postanaesthesia care unit (PACU) ‐Patients with recall of intraoperative awareness (Cn, %)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Insufficient information about the sequence generation process
Allocation concealment (selection bias)	Unclear risk	Insufficient information about the allocation concealment
Incomplete outcome data (attrition bias) All outcomes	Low risk	No missing outcome data
Selective reporting (reporting bias)	Low risk	All expected outcomes reported
Other bias	Unclear risk	The unblinded anaesthesiologist could potentially lead to ' learning information bias'
Blinding of patients?	Low risk	Patients were anaesthetized
Blinding of anaesthesiologists?	High risk	".... , the real time AAI and BIS values were only made available during the procedure to those anaesthesiologists caring for patients in the AEP or BIS‐guided groups,..." This indicates no blinding of anaesthesia care providers
Blinding of outcome assessors?	Low risk	" Emergence times were determined .......by a blinded observer." This indicates blinding of outcome assessors