BIS guide for clinicians

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Using BIS Monitoring to Reduce Intraoperative Awareness In the other randomized trial involving patients at increased risk for awareness, BIS monitoring was initiated prior to induction, and the delivery of anesthetics was titrated to maintain BIS values between 40 to 60 from laryngoscopy until wound closure. 6 This care resulted in an 82% reduction in the incidence of awareness (Figure 7). Incidence of Awareness 1.0% 0.8% 0.6% 0.4% 0.2% 0.0% 11/ 1,238 Control 2/ 1,225 BIS Figure 7: BIS monitoring reduced awareness by 82% in patients at increased risk for awareness. 6 In each study, two episodes of awareness were reported in patients despite the use of BIS monitoring. All four cases of awareness occurred during periods of significant noxious stimulation (e.g., intubation, median sternotomy) and were associated with BIS values near or greater than 60. These cases highlight the need for the anesthesia professional to be particularly vigilant to BIS responses to noxious stimulation and to be prepared to intervene promptly when BIS values exceed 60 for some time. 33
Intraoperative Awareness & Anesthesia Practice In addition to the ASA, professional societies from around the world have addressed the specific topic of brain monitoring to prevent awareness. The American Association of Nurse Anesthetists, 49 the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, 50 and the Australian and New Zealand College of Anesthetists 51 emphasize that brain function monitors be considered for use and/or available in clinical situations that place a patient at increased risk for awareness. For example, the AANA's 2006 Position Statement advised that “brain function monitoring, if available, should be considered particularly in situations where the risk of intraoperative awareness is increased.” 49 These statements augment the opinions of ASA members: 69% of ASAmembers surveyed in the Practice Advisory agreed or strongly agreed with the statement: “Brain function monitors are valuable and should be used to reduce the risk of intraoperative awareness for patients with conditions that may place them at risk for intraoperative awareness.” It should be appreciated that other patients, without recognized risk factors, will experience awareness due to unanticipated or unrecognized intraoperative events. It is important to remember the clinical evidence demonstrating the efficacy of BIS monitoring in this situation as well. 5 34
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
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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 and 36: AVOIDING AWARENESS ALGORITHM Preope
Page 37: BIS Monitoring and Awareness: Evide
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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