BIS guide for clinicians

More documents

Recommendations

Info

The Evolving Role of Brain Function Monitoring The Evolving Role of Brain Function Monitoring Despite remarkable improvements in the assessment of the cardiovascular and respiratory systems during anesthesia, determination of the effect of anesthetic agents on the central nervous system had remained a challenge. Now, technologies that permit routine neurophysiologic monitoring of the central nervous system provide a direct measure of anesthetic effect during anesthesia. 52 Combining brain function monitoring with traditional monitoring and assessment of clinical signs, can provide the anesthesia professional a more complete approach to optimizing the selection and/or dosing of anesthetic and adjuvant agents for each patient. Concerns regarding the consequences of both inadequate and excessive anesthetic effect have increased in the last few years. As noted previously, inadequate anesthetic effect is the primary etiology of unintentional intraoperative awareness. 41 This adverse event was discussed in detail in the previous section. Excessive anesthetic effect also has consequences. In some situations, excessive anesthetic effect may result in cardiovascular depression, and very rarely, cardiac arrest. 53 More recently, new concerns about other consequences of excessive anesthetic effect have appeared. Exposure to high doses of volatile anesthetic is a risk for acute transient epileptiform changes in the EEG. 54 In addition, excessive anesthetic effect has been associated with adverse long-term 55, 56 outcome. 35
The ability of brain function monitoring to allow the anesthesia professional to monitor patient-specific anesthetic effect is important. Avoidance of excessive anesthetic effect reduces the occurrence of prolonged 4, 36, 57 recovery and delayed orientation. As future investigations and clinical experience establish the potential short-term and long-term risks of excessive anesthetic effect, it may become important for anesthesia professionals to better modulate patient exposure to anesthesia. Given the increasing recognition of consequences of excessive – as well as inadequate – anesthetic effect, it is likely that more anesthesia clinicians will integrate brain function monitoring into overall anesthesia management. 36
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 and 36: AVOIDING AWARENESS ALGORITHM Preope
Page 37 and 38: BIS Monitoring and Awareness: Evide
Page 39: Intraoperative Awareness & Anesthes
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?