6/27/23, 11:41 PM BALANCED Pathway Feedback Search Clinical Topics Home Studies BALANCED BALANCED Trial question What is the role of light general anesthesia among patients at increased risk of complications after major surgery? Study design Multi-center Single blinded RCT Population Characteristics of study participants 36.0% female N = 6644 64.0% male 6644 patients (2423 female, 4221 male) Inclusion criteria: patients with increased risk of complications after major surgery Key exclusion criteria: inability to place electrodes and monitor the bispectral index because of the site of surgery; planned wake-up test; use of nitrous oxide, propofol infusion for maintenance of anesthesia, or ketamine at an infusion rate > 25 mg/hour Interventions N=3316 light general anesthesia (bispectral index target 50) N=3328 deep general anesthesia (bispectral index target 35) Primary outcome Death from all causes at 1 year 7.2 % 7.2 6.5 5.4 % 3.6 % 1.8 % No significant difference 0.0 % Light general anesthesia Deep general anesthesia https://web.pathway.md/studies/recgCdregxGp5hfW6 1/2 6/27/23, 11:41 PM BALANCED Pathway No significant difference in death from all causes at 1 year (6.5% vs. 7.2%; HR 0.88, 95% CI 0.73 to 1.07) Secondary outcomes No significant difference in myocardial infarction (2% vs. 2%; HR 1, 95% CI 0.73 to 1.38) No significant difference in PE (1% vs. 1%; HR 0.77, 95% CI 0.49 to 1.22) Safety outcomes No significant difference in grade 3 and grade 4 adverse events. Conclusion In patients with increased risk of complications after major surgery, light general anesthesia was not superior to deep general anesthesia with respect to death from all causes at 1 year. Reference Timothy G Short, Douglas Campbell, Christopher Frampton et al. Anaesthetic depth and complications after major surgery: an international, randomised controlled trial. Lancet. 2019 Nov 23;394(10212):1907-1914. Open reference URL https://web.pathway.md/studies/recgCdregxGp5hfW6 2/2