BIS guide for clinicians

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.
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