Bis-Guided Titration of Anesthetic Depth as a Means of Improving Perioperative Outcomes in Surgical Correction of Congenital Heart Defects in Children

Background: Surgical correction of congenital heart defects (CHD) in early childhood is performed under conditions in which conventional clinical signs of anesthetic depth are distorted by the underlying cardiac pathology, cardiopulmonary bypass and vasoactive support, while the developing brain remains vulnerable to both insufficient and excessive anesthetic exposure. Objective, processed-EEG guidance of anesthetic titration may therefore be a practical means of improving the safety of pediatric cardiac anesthesia. Objective: To assess the clinical effectiveness of anesthetic depth titration guided by the Bispectral Index (BIS) in the perioperative period of surgical CHD correction in children. Materials and Methods: A prospective observational study was carried out at the National Children's Medical Center and Ixlos Private Clinic (Tashkent, Uzbekistan) between 2023 and 2025. A total of 104 children undergoing CHD correction were enrolled: 74 received BIS-guided anesthesia (study group) and 30 were managed without BIS monitoring (control group). Anesthetic consumption, hemodynamic parameters, recovery characteristics and postoperative outcomes were compared between the groups. Results: BIS-guided anesthesia offered clear advantages over conventional clinical assessment. Compared with the control group, the study group required 28.4% less anesthetic agent (p<0.001), emerged from anesthesia 34.2% faster (p<0.001), had 23.7% fewer episodes of hypotension (p<0.01) and a 41.3% lower incidence of postoperative delirium (p<0.05). Conclusion: BIS-guided titration of anesthetic depth during CHD correction in children allows more precise control of hypnotic depth, lowers anesthetic requirements, accelerates recovery and increases overall perioperative safety.