BIS guide for clinicians

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BIS Monitoring During Typical GA BIS Value* Management Strategy High value • Assess level of surgical stimulation • Confirm delivery of hypnotics/analgesics • Consider ↑ hypnotic/ ↑ analgesic dosing • Consider antihypertensive administration Desired range (e.g., BIS 45 to 60) • Assess level of surgical stimulation • Consider ↑ analgesic dosing • Consider antihypertensive administration Low value • Consider antihypertensive administration • Assess level of surgical stimulation • Consider ↓ hypnotic/ ↑ analgesic dosing High value • Assess level of surgical stimulation • Consider ↑ hypnotic dosing • Consider ↑ analgesic dosing Desired range (e.g., BIS 45 to 60) • Continue observation Low value • Consider ↓ hypnotic dosing • Consider ↓ analgesic dosing High value • Consider blood pressure support • Assess for other etiologies • Consider ↑ hypnotic/ ↑ analgesic dosing Desired range (e.g., BIS 45 to 60) • Assess for other etiologies • Consider blood pressure support Low value • Consider ↓ hypnotic/ ↓ analgesic dosing • Consider blood pressure support • Assess for other etiologies * Potential impact of artifact should be considered when interpreting BIS values. 17
Special Issues Impacting BIS Monitoring Numerous prospective trials demonstrate that despite the potential for artifact and other issues, reliable BIS values can 5, 34 be obtained throughout many types of clinical cases. However, in certain circumstances, BIS values may not be an accurate reflection of the hypnotic state. As noted, BIS monitoring is an adjunct to clinical judgment, not a substitute for it. The clinician should be prepared to identify and respond to situations where the underlying EEG signals – and hence the BIS value – may not accurately reflect the clinical endpoints of sedation and hypnosis. For example, BIS values >60 may occur as the result of external artifacts, certain pharmacologic agents, or other unrelated causes rather than reflecting inadequate anesthetic effect and the potential for intraoperative awareness. Similarly, BIS values
Page 2 and 3: Monitoring Consciousness Using the
Page 4: Table of Contents Executive Overvie
Page 7 and 8: With progressive drug-induced sedat
Page 9 and 10: 4 Important Information About Using
Page 11 and 12: the correlation between all the fre
Page 13 and 14: It should be noted that the BIS ind
Page 15 and 16: halothane has been found to have hi
Page 17 and 18: Table 1: BIS monitoring during a ge
Page 19 and 20: Integrating BIS Information During
Page 21: Table 2: Anesthesia management stra
Page 25 and 26: Table 3: Reported factors influenci
Page 27 and 28: Table 4: BIS increase/high value as
Page 29 and 30: Clinical Impact of BIS Monitoring T
Page 31 and 32: Table 6: Potential risk factors for
Page 33 and 34: ASA Practice Advisory The “Practi
Page 35 and 36: AVOIDING AWARENESS ALGORITHM Preope
Page 37 and 38: BIS Monitoring and Awareness: Evide
Page 39 and 40: Intraoperative Awareness & Anesthes
Page 41 and 42: The ability of brain function monit
Page 43 and 44: References 1. Sigl J, et al. J Clin
Page 45 and 46: 45. Mychaskiw G, et al. Anesth Anal

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