BIS monitoring : a new kid on the block!!!

DR.RAJESH.T.EAPEN ANESTHESIOLOGIST GENERAL HOSPITAL TATA TE LTD MUNNAR

History of anesthesia
Anesthesia, the general or localized insensitivity to pain or other sensation general anesthesia during surgery is to render the patient unconscious, prevent pain and ensure a quiet surgical field with minimal movement during a surgical procedure. With the discovery in the mid-1800s that nitrous oxide ("laughing gas") and ether made patients insensitive to pain, the practice of anesthesia was born, making surgery a viable option for many conditions.
July 24, 2011 Dr.Rajesh - for IMA meeting 2

History of anesthesia..contd...
Today, a combination of anesthetic drugs accomplishes the needed results: analgesic drugs provide pain relief; muscle relaxants ensure the patient doesn't move; and hypnotic drugs make the patient unconscious.

July 24, 2011

Dr.Rajesh - for IMA meeting

Challenge of anesthesia
For years, anesthesia providers relied on multiple monitors to measure the state of the patient during surgery, including heart rate, blood pressure and a variety of other vital signs. none of these measures directly correlated with consciousness. Clinicians, therefore, were forced to rely solely on the indirect measurements to gauge the appropriate dosage for each patient to remain unconscious and free of pain during surgery.
July 24, 2011 Dr.Rajesh - for IMA meeting 4

Challenge of anesthesia..
standard dosages based on the anesthetic needs of an average, middle-aged male were used to guide administration of anesthetics. These standards were not necessarily appropriate for other patients, including women, patients of different ages and those with serious underlying diseases, leaving patients at risk for under- and over-sedation.
July 24, 2011 Dr.Rajesh - for IMA meeting 5

Implications of under- or oversedation

under-sedation and over-sedation can lead to adverse clinical and economic outcomes. patients who receive too little anesthesia might experience intra-operative awareness, which can have long-term emotional implications, including posttraumatic stress disorder. Receiving too much drug can result in longer wake-up times, unnecessarily prolonged recoveries and, frequently, nauseous recoveries.
July 24, 2011 Dr.Rajesh - for IMA meeting 6

The BIS Solution

Bispectral Index Monitor (Aspect Medical Systems) became the first company to provide a commercially available measure to assess consciousness during anesthesia and sedation. directly monitors a patient's level of consciousness.
July 24, 2011 Dr.Rajesh - for IMA meeting 7

Video on basics of anesthesia:

July 24, 2011

Dr.Rajesh - for IMA meeting

What is a BIS monitor?

a medical device that measures your brain wave activity, and provides your anesthesia professional with information regarding your brain during surgery, anesthesia and sedation.

July 24, 2011

Dr.Rajesh - for IMA meeting

How is BIS monitoring done?

BIS monitoring is a non-invasive technology. A BIS sensor is placed on your forehead and then connected through a cable to a monitor. Together they measures your brain 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.
July 24, 2011 Dr.Rajesh - for IMA meeting 10

Benefits :
Patients receive lower doses of anesthetics or sedatives Patients wake up faster Patients are eligible for discharge from the PACU faster Patients experience higher-quality recoveries Patients are less likely to experience intraoperative awareness with recall Hospitals can reduce costs, including the costs of anesthetics and/or sedatives
Dr.Rajesh - for IMA meeting

July 24, 2011

11

How is BIS monitoring used during anesthesia?

to help adjust the amount of medications that 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 have anesthesia side-effects. If you get too little medicine, you are at greater risk of being awake during anesthesia.
July 24, 2011 Dr.Rajesh - for IMA meeting 12

Does BIS monitoring help prevent awareness?

effective method to decrease your chance of awareness. reduces the frequency of awareness more than 5-fold. BIS monitoring helps your anesthesia professional recognize those periods of an operation when you need more anesthesia medication to stay asleep, or identify potential problems with the anesthesia medications getting into your body.
July 24, 2011 Dr.Rajesh - for IMA meeting 13

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 at the end of surgery, have less nausea and vomiting, and be able to leave the recovery room sooner.

July 24, 2011

Dr.Rajesh - for IMA meeting

14

SUMMARY ON BIS MONITORING:

July 24, 2011

Dr.Rajesh - for IMA meeting

15

July 24, 2011

Dr.Rajesh - for IMA meeting

16