BIS Monitoring to Prevent Awareness during General Anesthesia

OʼConnor, Michael; Daves, Suanne M.; Tung, Avery; Cook, Richard I.; Thisted, Ronald A.; Apfelbaum, Jeffery L.

doi:10.1097/00000542-200103000-00025

Cited by 110 publications

(39 citation statements)

References 11 publications

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“…BIS scores range from 0 (flat line EEG) to 100 (fully awake) with values of 60-70 and greater than 70 corresponding to deep sedation and moderate sedation, respectively [29][30][31]. Initial studies of BIS or alternative EEG-based monitoring of sedation during endoscopy reported that these tools correlated well with the level of patient consciousness [32], and permitted more effective titration of propofol and faster recovery from sedation during endoscopy [33].…”

Section: Introductionmentioning

confidence: 99%

Bispectral Index Monitoring for Nurse-Administered Propofol Sedation During Upper Endoscopic Ultrasound: A Prospective, Randomized Controlled Trial

DeWitt

2008

Dig Dis Sci

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Bispectral index monitoring (BIS) is a quantitative assessment of brain cortical activity. The aim of this study was to determine if BIS-guided nurse-administered propofol sedation would decrease by > or = 20% both recovery time and propofol dose compared to standard propofol sedation for endoscopic ultrasound (EUS). Prospectively, eligible outpatients were randomized to BIS-guided or standard propofol sedation during EUS. Propofol was given by nurses in intermittent boluses with sedation targeted at a BIS score of < 65-75. For the control group, the nurse was blinded to BIS scores and sedation was titrated to a modified observer's assessment of alertness/sedation scale (MOAA/S) score < or = 3. Of 50 patients enrolled, data for 44 randomized to BIS-guidance (n = 24) and the control group (n = 20) were evaluated. Between the BIS-guided and control group there was no difference between the mean procedure duration, total propofol dose, recovery time, mean intraoperative MOAA/S, and mean BIS score. Compared to standard propofol sedation for EUS, BIS-guided propofol sedation offers no significant decrease in postprocedure recovery times or propofol doses.

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Section: Introductionmentioning

confidence: 99%

Bispectral Index Monitoring for Nurse-Administered Propofol Sedation During Upper Endoscopic Ultrasound: A Prospective, Randomized Controlled Trial

DeWitt

2008

Dig Dis Sci

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“…O'Conner et al konnten anhand einer Poweranalyse zeigen, dass in einer Studie zur Vermeidung von Awareness durch EEG-Monitoring zwischen 20.000 und 50.000 Patienten untersuchen werden müssten [58]. Dieses ist sehr aufwendig, und bisher wurden keine Studien publiziert, die dieses Kriterium erfüllen.…”

Section: Vermeidung Von Awarenessunclassified

Messung der Narkosetiefe

2007

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One of the most important mandates of the anaesthesiologist is to control the depth of anaesthesia. An unsolved problem is that a straight definition of the depth of anaesthesia does not exist. Concerning this it is rational to separate hypnosis from analgesia, from muscle relaxation and from block of cardiovascular reactions. Clinical surrogate parameters such as blood pressure and heart rate are not well-suited for a valid statement about the depth of hypnosis. To answer this question the brain has become the focus of interest as the target of anaesthesia. It is possible to visualize the brain's electrical activity from anelectroencephalogram (EEG). The validity of the spontaneous EEG as an anesthetic depth monitor is limited by the multiphasic activity, especially when anaesthesia is induced (excitation) and in deep anaesthesia (burst suppression). Recently, various commercial monitoring systems have been introduced to solve this problem. These monitoring systems use different interpretations of the EEG or auditory-evoked potentials (AEP). These derived and calculated variables have no pure physiological basis. For that reason a profound knowledge of the algorithms and a validation of the monitoring systems is an indispensable prerequisite prior to their routine clinical use. For the currently available monitoring systems various studies have been reported. At this time it is important to know that the actual available monitors can only value the sedation and not the other components of anaesthesia. For example, they cannot predict if a patient will react to a painful stimulus or not. In the future it would be desirable to develop parameters which allow an estimate of the other components of anaesthesia in addition to the presently available monitoring systems to estimate sedation and muscle relaxation. These could be sensoric-evoked potentials to estimate analgesia and AEPs for the detection of awareness.

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“…As noted earlier, BIS monitoring is an adjunct to clinical judgment, not a substitute for it. However, there are certain unusual circumstances that may produce inaccurate BIS readings, and clinicians will need to know how to recognize and manage those situations (O'Connor et al, 2001).…”

Section: Clinical Responses Using Bispectral Indexmentioning

confidence: 99%