BIS guide for clinicians

More documents

Recommendations

Info

Using BIS Monitoring to Reduce Intraoperative Awareness Use Multiple Modalities to Monitor Depth of Anesthesia to Minimize Occurrence of Awareness Clinical Signs Patient observation Movement Sweating, lacrimation Eyelash reflex, pupils Conventional Monitoring Blood pressure Heart rate Respiratory rate End-tidal agent Brain Function Monitoring Multiple technologies available Only BIS has data demonstrating 80% reduction in awareness Clinical Considerations Lack of studies measuring ability to reduce occurrence of awareness Use of NMB agents may mask somatic signs Avoiding paralysis does not prevent awareness Lack of studies measuring ability to reduce occurrence of awareness Awareness may occur with normal vital signs Cardiovascular medications (e.g., beta blockers) may mask signs GOAL: BIS 60 Figure 5: An algorithm approach to avoiding intraoperative awareness. 31
BIS Monitoring and Awareness: Evidence To date, the addition of BIS monitoring is the only monitoring intervention shown by scientific evidence to reduce intraoperative awareness. Two large, prospective trials have both found an approximate 80% reduction in the incidence of awareness when using BIS monitoring in addition to other routine monitors. 5, 6 In addition to these two large trials, other reports of BIS monitoring and intraoperative awareness have appeared in the literature. These include a small randomized controlled trial, 44 a large cohort observational study, 37 45, 46, 47, 48 as well as several case reports. The two large prospective trials provide a clinical management framework for effectively using BIS monitoring. In one investigation, the anesthesia staff was instructed to maintain BIS values within a range of 40 to 60, and to avoid values greater than 60 during induction and maintenance. 5 This management resulted in significant benefit: only two patients in the 4,945 treated patients reported awareness, representing a 77% reduction compared to the investigators' prior study (Figure 6). Incidence of Awareness 14/ 7,826 0.2% 0.1% 0.0% Historical Control 2/ 4,945 BIS Figure 6: BIS monitoring reduced awareness by 77% in routine patients undergoing relaxant general anesthesia. 5 32
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 and 32: Table 6: Potential risk factors for
Page 33 and 34: ASA Practice Advisory The “Practi
Page 35: AVOIDING AWARENESS ALGORITHM Preope
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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?