Background and Goal of Study: Bispectral index was specifically developed to measure the hypnotic effects of anaesthesia and allows better titration of anesthesia, resulting in lower hypnotic drug use and improved recovery. The study compared hemodynamic stability (± 20% from baseline mean arterial pressure - MAP) pediatric patients undergoing adenotonsillectomy using two standard anesthetic techniques - BIS-guided total intravenous anesthesia (TIVA) and inhalation anesthesia (VIMA).
Materials and methods: One hundred pediatric patients (ASA I and II) between 3-10 years of age were randomly divided into two groups: TIVA (T group, n = 50) and VIMA (V group, n = 50). In both groups, BIS value was maintained betwen 40 and 60. The values of MAP before surgery - baseline and during maintenance of anesthesia were measured and recorded. 
Results and discussion: The baseline MAP was 85.09 mmHg (SD = 14.55) in TIVA and 84.61 mmHg (SD = 10.70) in VIMA group. MAP during anaesthesia maintenance was 81.64 mmHg (SD = 9.40) in TIVA group and 77.73 mmHg (SD = 7.07) in VIMA group. The analysis of covariance (ANCOVA), there were statistically significant differences in MAP during anaesthesia maintenance between groups (taking into account the duration of the operation, as well as baseline MAP): F (1, 96) = 4.59, p = .035, η2 = .046, but without clinical importance. Hemodynamic instability (± 20% of initial blood pressure) is registered in 11 (22%) patients in the TIVA group, and 10 (20%) patients in the group VIMA. Using the chi-square test there was no statistically significant difference in the number of hemodynamically unstable patients: χ2 (1, N = 100) = 0.06, p = .81, w = .02.
Conclusion(s): BIS guided TIVA or VIMA shows no difference in hemodinamic stability during maintenance of anesthesia. Although statistically significant differences in the values of MAP during maintenance of anesthesia was noted, the same have no clinical significance.

TIVA vs. VIMA - BIS-guided anesthesia and hemodynamic stability in paediatric patients