Validation of the PRST Score Against Bispectral Index
Validation of the PRST Score Against Bispectral Index During General Anesthesia: A Randomized Controlled Trial
The goal of this randomized controlled trial is to evaluate whether the PRST (Evans) score is a valid method for monitoring the depth of general anesthesia in adult surgical patients. It will also assess whether combining the PRST score with Bispectral Index (BIS) monitoring improves anesthetic depth assessment compared with PRST-guided monitoring alone.
The main questions it aims to answer are:
- Does the PRST score correlate with BIS values during general anesthesia?
- Does visible BIS-guided monitoring improve anesthetic depth assessment compared with PRST-guided monitoring alone?
Researchers will compare patients managed using PRST-guided monitoring alone with patients managed using PRST plus visible BIS-guided monitoring.
Participants will:
- Undergo elective surgery under general anesthesia
- Receive intraoperative anesthetic depth monitoring using PRST score alone or PRST combined with BIS monitoring
- Have PRST score, BIS, heart rate, and blood pressure recorded at predefined intraoperative timepoints
- Complete a postoperative interview assessing recall, dreaming, and anesthesia-related discomfort
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
This single-center, parallel-group randomized controlled trial (RCT) aims to evaluate the validity of the PRST (Evans) score for monitoring the depth of general anesthesia and to assess its relationship with Bispectral Index (BIS) monitoring in adult surgical patients undergoing elective procedures under general anesthesia.
Intraoperative awareness remains a clinically important complication during general anesthesia. Traditional clinical assessment methods such as the PRST score evaluate autonomic responses including systolic blood pressure, heart rate, sweating, and lacrimation, whereas BIS provides an electroencephalography-based objective assessment of hypnotic depth. This study investigates whether combining PRST assessment with BIS monitoring may improve anesthetic depth evaluation compared with PRST-guided monitoring alone.
Eligible participants are randomized into either a PRST-guided monitoring group or a PRST plus visible BIS-guided monitoring group. Standard anesthetic induction and maintenance protocols are applied in both groups. In the intervention group, BIS monitoring is used as an adjunctive tool to guide anesthetic depth management, with a target BIS range of 40-60.
PRST score, BIS values, heart rate (HR), and mean arterial pressure (MAP) are recorded at predefined intraoperative timepoints including T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase). Postoperative interviews are conducted to evaluate recall, dreaming, and anesthesia-related discomfort.
The primary objective is to determine the association between PRST score and BIS values during general anesthesia. Secondary objectives include evaluation of hemodynamic responses, anesthetic delivery variables, postoperative recall-related events, and the diagnostic performance of PRST score in identifying BIS-defined light anesthesia.
Tipo de estudo
Inscrição (Real)
Estágio
- Não aplicável
Contactos e Locais
Locais de estudo
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Special Region of Yogyakarta
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Yogyakarta, Special Region of Yogyakarta, Indonésia, 55281
- RSUP Dr. Sardjito
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Descrição
Inclusion Criteria:
- Scheduled for elective surgery under general anesthesia
Exclusion Criteria:
- Unstable hemodynamic conditions
- Contraindications to specific anesthetic agents or significant neurological disorders (e.g., Parkinson's disease, stroke, or dementia)
- Receiving medications known to influence EEG activity, such as anticonvulsants
- Unable to provide informed consent
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Diagnóstico
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Dobro
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
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Comparador Ativo: Control (PRST group)
Participants in this group will undergo elective surgery under general anesthesia with anesthetic depth managed using standard clinical monitoring and PRST-guided assessment.
PRST components, including systolic blood pressure response, heart rate response, sweating, and lacrimation, will be assessed at predefined intraoperative timepoints.
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Clinical anesthetic depth monitoring using PRST score assessment without visible BIS-guided titration.
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Experimental: Intervention (PRST + BIS group)
Participants in this group will undergo elective surgery under general anesthesia with anesthetic depth managed using standard clinical monitoring, PRST-guided assessment, and visible BIS monitoring.
BIS monitoring will be initiated after induction and used as an adjunct to guide hypnotic depth titration, with a typical target BIS range of 40-60.
PRST score, BIS values, and hemodynamic parameters will be recorded at predefined intraoperative timepoints.
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Clinical anesthetic depth monitoring using PRST score combined with visible BIS-guided anesthetic titration targeting BIS 40-60.
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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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PRST score
Prazo: T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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PRST components were assessed as follows: SBP response (increase from baseline <15 mmHg = 0; 15-30 mmHg = 1; >30 mmHg = 2), HR response (increase from baseline <15 bpm = 0; 15-30 bpm = 1; >30 bpm = 2), sweating (absent = 0; present = 1), and lacrimation (absent = 0; present = 1).
The total PRST score ranged from 0 to 6 with higher scores indicating greater autonomic response to nociceptive stimuli.
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T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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BIS Score
Prazo: T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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Bispectral Index (BIS) monitoring is an electroencephalography-based anesthetic depth monitoring system used to assess the hypnotic state during general anesthesia.
In this study, BIS monitoring is initiated after anesthetic induction and used as an adjunctive tool to guide anesthetic depth management, with a target BIS range of 40-60 during maintenance of general anesthesia.
Continuous BIS values are recorded throughout the intraoperative period to evaluate anesthetic depth and correlation with PRST score measurements.
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T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Heart Rate
Prazo: T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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Mean Arterial Pressure
Prazo: T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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T0 (baseline before induction), T1 (after induction before laryngoscopy), T2 (1-3 minutes after airway instrumentation), T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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Sevoflurane dial setting
Prazo: T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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Sevoflurane dial setting refers to the vaporizer concentration setting used to deliver inhaled sevoflurane during maintenance of general anesthesia.
In this study, sevoflurane concentration is adjusted intraoperatively according to anesthetic depth assessment and clinical monitoring parameters, including PRST score and BIS monitoring when applicable.
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T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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End-tidal minimum alveolar concentration (MAC) values
Prazo: T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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End-tidal minimum alveolar concentration (MAC) values represent the measured concentration of inhaled anesthetic agent in exhaled gas and are used as an indicator of anesthetic potency during general anesthesia.
In this study, end-tidal MAC values are continuously monitored intraoperatively and recorded at predefined timepoints to evaluate anesthetic delivery and depth of anesthesia in relation to PRST score and BIS monitoring.
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T3 (before skin incision), T4 (5 minutes after incision), and T5-T6 (15 and 30 minutes during the maintenance phase).
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Postoperative discomfort
Prazo: Immediately after recovery from general anesthesia
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Postoperative discomfort refers to patient-reported unpleasant physical or psychological experiences following general anesthesia and surgery.
Assessment is performed postoperatively using structured interview questions evaluating discomfort related to anesthesia, intraoperative experience, or recovery period.
Responses are recorded and compared between study groups.
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Immediately after recovery from general anesthesia
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Dreaming
Prazo: Immediately after recovery from general anesthesia
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Dreaming refers to patient-reported dream experiences occurring during the peri-anesthetic period under general anesthesia.
Assessment is performed postoperatively using structured interview questions adapted from the modified Brice interview to identify the presence or absence of dreaming during anesthesia and recovery.
Responses are recorded and compared between study groups.
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Immediately after recovery from general anesthesia
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Colaboradores e Investigadores
Patrocinador
Datas de registro do estudo
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Enviado pela primeira vez
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Mais Informações
Termos relacionados a este estudo
Palavras-chave
Outros números de identificação do estudo
- PRST-BIS-RCT-2026
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