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Data from: Risk factors for burst suppression ratio during general anesthesia: A retrospective monocenter study

Pierre, Hammoum1; Yves, Auffray1; Benjamin, Salze1; Amaury, de Freminville1; Trillat, Bernard1; Jerôme, Cartailler2; Morgan, Le Guen1; Fischler, Marc1

Published Mar 31, 2026 on Dryad. https://doi.org/10.5061/dryad.r7sqv9sqg

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Abstract

Burst suppression (BS), characterized by alternating high-voltage bursts and suppressed EEG activity, is common during deep anesthesia and may be associated with adverse outcomes. The bispectral index (BIS) monitor calculates a suppression ratio (SR) to quantify BS, but risk factors for high SR remain underexplored, particularly by sex. The main purpose of the present study was to identify preoperative and intraoperative factors associated with high SR in patients undergoing general anesthesia with tracheal intubation, stratified by sex. Retrospective, single-center cohort study of adult patients undergoing general anesthesia for scheduled non-cardiac surgery between October 2014 and December 2019. SR was calculated as the area under the curve (AUC) of SR values >0, with the highest quartile defining the High SR group. Logistic regression models identified risk factors using stepwise variable selection. Our study examined 10,827 patients. SR occurred in 71.5% of patients, more frequently in men (76.2%) than women (66.4%; p<0.001). High SR (SR >124.5 for men, >67 for women) was associated with age >46 years and propofol maintenance in both sexes. Men had additional risks from higher ASA scores, ATC Blood/Nervous System medications, rocuronium, or no neuromuscular blocker. Women showed risks from neurosurgery, ENT, thoracic, or vascular surgeries, and remifentanil use. Age and propofol are key risk factors for high SR, with sex-specific factors suggesting tailored monitoring strategies. These findings underscore the need for refined BIS-guided anesthesia protocols.