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BIS monitoring

: a new kid on the block!!!

DR.RAJESH.T.EAPEN

ANESTHESIOLOGISTGENERAL HOSPITAL

TATA TE LTD

MUNNAR

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History of anesthesia

Anesthesia, the general or localizedinsensitivity to pain or other sensation

general anesthesia during surgery is torender the patient unconscious, preventpain and ensure a quiet surgical fieldwith minimal movement during asurgical procedure.

With the discovery in the mid-1800s thatnitrous oxide ("laughing gas") and ether

made patients insensitive to pain, thepractice of anesthesia was born, makingsurgery a viable option for manyconditions.

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History of anesthesia..contd...

Today, a combination of anesthetic

drugs accomplishes the needed

results: analgesic drugs providepain relief; muscle relaxants

ensure the patient doesn't move;

and hypnotic drugs make the

patient unconscious.

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Challenge of anesthesiaFor years, anesthesia providers relied

on multiple monitors to measure thestate of the patient during surgery,including heart rate, blood pressureand a variety of other vital signs.

none of these measures directlycorrelated with consciousness.Clinicians, therefore, were forced torely solely on the indirectmeasurements to gauge theappropriate dosage for each patient toremain unconscious and free of painduring surgery.

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Challenge of anesthesia..

standard dosages based on theanesthetic needs of an average,middle-aged male were used to guide

administration of anesthetics. Thesestandards were not necessarilyappropriate for other patients,including women, patients of differentages and those with seriousunderlying diseases, leaving patientsat risk for under- and over-sedation.

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Implications of under- or over-

sedation

under-sedation and over-sedation can leadto adverse clinical and economicoutcomes.

patients who receive too little anesthesia

might experience intra-operativeawareness, which can have long-termemotional implications, including post-traumatic stress disorder.

Receiving too much drug can result inlonger wake-up times, unnecessarilyprolonged recoveries and, frequently,nauseous recoveries.

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The BIS Solution

Bispectral Index Monitor (Aspect

Medical Systems) became the first

company to provide a commerciallyavailable measure to assess

consciousness during anesthesia and

sedation.

directly monitors a patient's level of

consciousness.

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Video on basics of anesthesia:

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What is a BIS monitor?

a medical device that measures your brainwave activity, and provides your anesthesia

professional with information regarding

your brain during surgery, anesthesia and

sedation.

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How is BIS monitoring done?

BIS monitoring is a non-invasivetechnology.

A BIS sensor is placed on your forehead

and then connected through a cable to a

monitor. Together they measures yourbrain activity and then computes a number

between 0 and 100 which corresponds to

your level of consciousness which is known

as the BIS value.Once the procedure has ended, the sensor

is removed from your forehead.

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Benefits :

Patients receive lower doses of anestheticsor sedatives

Patients wake up faster

Patients are eligible for discharge from thePACU faster

Patients experience higher-quality

recoveries

Patients are less likely to experience intra-operative awareness with recall

Hospitals can reduce costs, including the

costs of anesthetics and/or sedatives

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How is BIS monitoring used

during anesthesia?

to help adjust the amount of medicationsthat you are receiving during the operation.

By knowing how you are responding to the

medications, they can change the amount

of medication to be certain you are not

getting too much or too little anesthesia.

patients getting too much anesthesia

medication are more likely to haveanesthesia side-effects. If you get too little

medicine, you are at greater risk of being

awake during anesthesia.

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Does BIS monitoring improve

recovery from anesthesia?

the amount of medication given to you

is reduced by one-fifth.

you will generally wake up faster atthe end of surgery, have less nausea

and vomiting, and be able to leave the

recovery room sooner.

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SUMMARY ON BIS MONITORING:

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