Guidelines for Complications of Cancer Treatment Vol VIII Part B

anaesthesia reduced the risk of awareness by 82% (95% CI17-98%).Interpretation: BIS-guided anaesthesia reduces the risk ofawareness in at-risk adult surgical patients undergoing relaxantgeneral anaesthesia. With a cost of routine BIS monitoring atUS16 dollars per use in Australia and a number needed totreat of 138, the cost of preventing one case of awareness inhigh-risk patients is about 2200 dollars.Anesthesia awareness and the bispectral indexAvidan MS, Zhang L, Burnside BA, Finkel KJ,Searleman AC, Selvidge JA, Saager L, Turner MS,Rao S, Bottros M, Hantler C, Jacobsohn E,Evers AS. N Engl J Med. 2008 Mar 13;358(11):1097-108Background: Awareness during anesthesia is a seriouscomplication with potential long-term psychologicalconsequences. Use of the bispectral index (BIS), developedfrom a processed electroencephalogram, has been reported todecrease the incidence of anesthesia awareness when the BISvalue is maintained below 60. In this trial, Authors sought todetermine whether a BIS-based protocol is better than aprotocol based on a measurement of end-tidal anesthetic gas(ETAG) for decreasing anesthesia awareness in patients at highrisk for this complication.Methods: Authors randomly assigned 2000 patients to BISguidedanesthesia (target BIS range, 40 to 60) or ETAG-guidedanesthesia (target ETAG range, 0.7 to 1.3 minimum alveolarconcentration [MAC]). Postoperatively, patients were assessedfor anesthesia awareness at three intervals (0 to 24 hours, 24to 72 hours, and 30 days after extubation).Results: Authors assessed 967 and 974 patients from the BISand ETAG groups, respectively. Two cases of definite72