BIS guide for clinicians

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Using BIS Monitoring to Reduce Intraoperative Awareness The presumed cause of intraoperative awareness is a period of inadequate anesthetic effect resulting from an insufficient anesthetic dose, disruption of anesthetic delivery, or potentially inherent anesthetic resistance. 41 For example, in some clinical situations, administration of very low anesthetic doses may be appropriate in light of hemodynamic compromise or other clinical goals. These doses, however, are associated with a higher frequency of intraoperative awareness. Patient reports include frightening descriptions of intraoperative awareness, highlighting the potential horrendous sensations and emotions that may occur if anesthetic effect is inadequate. 42 Patients who experience intraoperative awareness may develop a spectrum of psychological injury ranging from mild, transient symptoms to severe, disabling symptoms consistent with post-traumatic stress disorder. 43 27
ASA Practice Advisory The “Practice Advisory for Intraoperative Awareness and Brain Function Monitoring” published in 2006 describes using multiple monitoring modalities – clinical techniques, conventional monitoring and brain function monitoring – to assess anesthetic depth and reduce the likelihood of intraoperative awareness. 21 The Practice Advisory consensus opinion was that “the decision to use a brain function monitor should be made on a case-by-case basis by the individual practioner for selected patients.” It should be noted that the Practice Advisory also stated that brain monitoring is not routinely indicated for all patients undergoing general anesthesia, and that brain function monitoring currently has the same status as the many other monitoring modalities used in selected situations determined by individual clinicians. The ASA Practice Advisory aims to help the anesthesia professional develop a clinical strategy to minimize the occurrence of awareness. Such a strategy involves elements of care occurring throughout the perioperative period – preoperative assessment and preparation, intraoperative monitoring and intervention, and postoperative follow-up activities. An overview of the resulting clinical strategy is presented in Table 7. Alternatively, clinicians may wish to implement the algorithm approach presented in Figure 5 to minimize the risk for awareness. 28
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 and 30: Clinical Impact of BIS Monitoring T
Page 31: Table 6: Potential risk factors for
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

BIS guide for clinicians

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