Limitations of anaesthesia depth monitoring

Abstract

Clinicians should be aware of the several limitations of the commercial devices intending to monitor the depth of anaesthesia, which may not reflect the real underlying level of unconsciousness.

Is there an appropriate bispectral index for upper gastrointestinal endoscopy in spontaneous breathing in the pediatric patient?

“…12 Propofol was chosen for this protocol because it is widely used in invasive pediatric procedures 3,7,9,13 ; when administered correctly during induction, it prevents apnoea. 14 We know that even at ''deep'' BIS levels some patients can display motor reflexes, and this can reduce the effectiveness of BIS in predicting whether a patient will react during performance of EGD. A lighter level of anaesthesia can reduce the risk of airway compromise, but might not prevent motor response.…”

¿Existe un valor de índice biespectral adecuado para endoscopias digestivas altas en respiración espontánea en el paciente pediátrico?

“…Dicha respuesta motora al dolor y los reflejos provocados al manipular estructuras de la boca, faringe y esófago no se generan a nivel de corteza cerebral: se producen en zonas subcorticales (tronco, médula espinal). En la actualidad, aunque se sabe que los fármacos anestésicos ejercen su efecto tanto a nivel cortical como subcortical, solo se dispone de monitorización del efecto anestésico a nivel cortical 14 . Es un hecho que con niveles de BIS considerados «profundos» algunos pacientes pueden tener presentes arcos motores reflejos; por eso el BIS puede no ser tan efectivo para predecir si el paciente va a tener o no alguna reacción durante la realización de EDA; incluso hay trabajos que indican que ni el BIS ni la entropía pueden diferenciar claramente un estado de consciencia de inconsciencia 15 .…”

Modern Anesthetic Noninvasive Monitoring: A Deep Look into Perioperative Care

“…Even though the widespread use of brain monitors based on these processed EEG numerical scales constituted a significant advance in brain function monitoring within the practice of anesthesiology, they all have significant limitations. 8,9 To date, with the lack of effective consideration of neurobiologic background that is commonly encountered in these monitors (eg, not taking into account the normal electroencephalographic changes with all ages including changes seen in the elderly, or, the fragile brain of sick patients), there is a strong call to integrate raw EEG and spectral analysis into a broad monitoring strategy that allows the clinician to be aware of the neuroelectrical cerebral activity. By doing so, one can individualize anesthetics dosing while being able to observe the dynamic state of the brain during anesthesia or sedation.…”