BIS guide for clinicians

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Using BIS Monitoring to Reduce Intraoperative Awareness Using BIS Monitoring To Reduce Intraoperative Awareness Despite best intentions, a small percentage of patients undergoing general anesthesia regain consciousness unexpectedly and are able to form sufficient memory to recall portions of their intraoperative experience. This section discusses the role that BIS monitoring can play in decreasing the incidence of this adverse event. Intraoperative Awareness During Anesthesia In several large-scale prospective investigations, the incidence of intraoperative awareness has been measured to occur 37, 38, 39 during general anesthesia in 0.1 to 0.2% of patients. In 2004, the Joint Commission’s Sentinel Event Alert #32 noted that each year, 20,000 to 40,000 patients may become cognizant and have recall of events during surgery. 40 An overview of various perioperative factors that put patients at increased risk for awareness is presented in Table 6. Presence of some of these risk factors has been reported to increase the relative risk for awareness to nearly 1% of patients. 25
Table 6: Potential risk factors for awareness: an overview. Patient and Anesthetic History Surgical Procedures Anesthetic Management Previous episode of awareness Substance use or abuse Chronic pain patients on high doses of opioids History of or anticipated difficult intubation ASA physical status 4 to 5 Limited hemodynamic reserve Cardiac, trauma, emergency surgery Cesarean section Planned use of: • Muscle relaxants during maintenance phase • Total intravenous anesthesia • Nitrous oxide–opioid anesthesia Reduced anesthetic doses during paralysis 26
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 and 22: Table 2: Anesthesia management stra
Page 23 and 24: Special Issues Impacting BIS Monito
Page 25 and 26: Table 3: Reported factors influenci
Page 27 and 28: Table 4: BIS increase/high value as
Page 29: Clinical Impact of BIS Monitoring T
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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