BIS guide for clinicians

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Using BIS Monitoring to Reduce Intraoperative Awareness The Practice Advisory also alerted anesthesia clinicians to recognize that dosing anesthetic agents to achieve certain brain function values in an attempt to prevent intraoperative awareness may conflict with other medical concerns including vital organ function and existing co-morbidity. 21 Similarly, the Joint Commission’s Sentinel Event Alert #32 noted that anesthesia professionals must weigh the psychological risks of anesthesia awareness against the physiological risks of excessive anesthesia. 40 Table 7: Clinical strategy to minimize awareness: an overview. Preoperative Period Intraoperative Period Postoperative Period Assess risk: • Patient • Procedure • Anesthetic technique Provide informed consent in high-risk situations Consider premedication to provide amnesia Use multiple modalities to assess anesthetic depth • Clinical signs - Masked with use of muscle relaxant • Conventional monitoring - BP, HR, end-tidal agent • Brain function monitoring (e.g., BIS) Consider amnestics for unintended consciousness Assess patient reports of awareness Provide patient with appropriate follow-up care Report occurrence for quality assurance purposes 29
AVOIDING AWARENESS ALGORITHM Preoperative Patient Assessment Previous episode of awareness Anticipated tolerance to opioids or sedatives Known or anticipated difficult airway Known or anticipated hemodynamic instability Surgical procedure with increased risk for awareness Anesthesia Management Plans Muscle relaxant use during maintenance phase Reduced anesthetic doses during paralysis Total intravenous anesthesia Nitrous oxide-opioid anesthesia Does Patient Have Risk Factors For Awareness? Inform patient of possibility of awareness YES Consider prophylactic administration of benzodiazepine 30
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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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