BIS Monitor

  1. I just finished watching "When Anesthesia Fails" on the Discovery Health channel, it was very interesting to say the least. They mentioned the BIS Monitor and I was wondering if anyone here has had any experience with the monitoring device and, if so, if they would please share some information about their experience with the device.

    Thanks, Linda
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  2. 18 Comments

  3. by   shudokan-RN
    Linda I'm not a CRNA, just a circulator. Our anesthesia group had a trial liked them and the hospital purchased them for all 10 OR's. the sandmen liked them, because they were able to use less anesthesia, and patients woke up more quickly. also you could see when they were too light and feeling discomfort.
    marci
  4. by   Passin' Gas
    I've been a CRNA for 8+ years. Lots of "big" cases and "quick" cases. The BIS monitor only added verification to what I have learned over time how to assess anesthetic depth based on patient observation. It changed nothing that I have done for the past 8+ years. Great tool to help, not an end all to monitor anesthetic depth. Remember, MONITOR THE PATIENT, NOT THE MONITORS!
  5. by   alansmith52
    is there any worry that someday down the line after much research that this could in someway, belittle the job of the anesthesia provider.
    matt
  6. by   KC CHICK
    Originally posted by alansmith52
    is there any worry that someday down the line after much research that this could in someway, belittle the job of the anesthesia provider.
    matt
    I wouldn't think so considering that man made machines can -and do- fail. Like another poster said....monitor the patient and not the monitors!
    Dinamap machines didn't replace RNs....why would this replace CRNAs?
  7. by   Passin' Gas
    Interesting point.

    "With the advent of the then "high-tech" EEG in 1950, Courtin et al sought to monitor the brain and devise a servo-controlled system that could adjust the anesthetic concentration administered on the basis of the EEG pattern. " Miller, Anesthesia p 1328.

    He goes on to say that due to the many different classes of drugs used in a single anesthetic, all of which affect the EEG, it is difficult to interpret the EEG. There are many different anesthetic techniques; inhalation agent with or without nitrous oxide, narcotic-based with a little gas for amnesia, TIVA (total IV anesthesia), etc. These all have different effects on EEG parameters. Therefore, it is difficult to develop a monitor which will accurately assess the various drugs involved and determine anesthetic depth.

    The bispectral index monitor can be indicative of loss of consciousness and recall. Another important part of an anesthetic is preventing hemodynamic response or movement in response to surgical stimulation. The BIS monitor does not reliably monitor these responses.

    With today's technology, despite how rapidly it is developing, my vigilance is still the best monitor.

    PG :zzzzz
  8. by   nilepoc
    At one of the clinical sites I have gone to, they are primarily used as coat racks. (at least that is the joke that gets told to the rep, when he brought us lunch).

    Actually several of the providers use them, but generally not the older practitioners.

    I am still waiting to see my first case, where one is used as more than a coat rack.

    craig

    BTW as stated above, We are taught that the number one safety preperation is vigilance.
  9. by   yoga crna
    I don't need a monitor to tell me when a patient is light, everyone in the operating room tells me if the patient is moving. Like I don't know it. Honestly, I have seen the BIS used and was unimpressed. I am an "old" anesthetist and learned to administer anesthesia without any monitors except a precordial stethoscope and BP cuff. If you watch the patient and watch the surgery, you don't need a lot of distractions such as numbers on a monitor.

    I know all of you will be critical of my views on this, but too many people give anesthesia according to the monitors, without assessing what is happening. Also, there are a lot of artifacts with all monitors. That being said, I do monitor all vitals, except BIS and my patients do well.
    YogaCRNA
  10. by   alansmith52
    very good i just wanted to stimulateome chatter
  11. by   Tenesma
    i am all for the BIS monitor... there is very good evidence to show that by using the BIS you can optimize depth of anesthesia - thus reducing the amount of anesthetic the patient is exposed to, and thus affecting wake-up and recovery time - something the hospital/the insurer and most importantly the patient are thankful for... i will post the references when i get back to work.

    as far as artifact goes, the newest generation of BIS monitors has better software and an extra lead to help blur out the background electrical activity - while not perfect, it is definitely going in the right direction.

    now i don't use a BIS for every case, but i am using it more and more often and with great results... some of my favorite situations are when patients are paralyzed, have an epidural running during the case - how do you assess depth of anesthesia? their hemodynamics will be all screwed up and they definitely won't be moving

    sometimes the chatter i hear from "older" anesthesia providers is similar to what used to be said about pulse oximetry, and then about dynamap (automatic) blood pressure cuffs... anesthesia has been in search of a depth-o-meter for a long time, and the BIS is the closest we are coming to... and i also don't understand this whole monitor the patient, not the monitors: those monitors are there for a reason because you can't tell somebody's heart rate/blood pressure/ICP/etc, by staring at their forehead or at the surgical field..
  12. by   WntrMute2
    I have to agree with Tenesma here on a couple of different levels. I think you use all the equipment available to help provide patient safety. What do you think your patient would say if you gave them the choice of using the BIS monitor or no monitor. I also think about a lawsuit revolving areound recall could go like this: Lawyer- "Mr CRNA, thereis a monitor in your operating room that helps determine whether your patient is aware. Is that true?" CRNA- "yes." Lawyer- "Did you use it on this case?" CRNA- "No." Lawyer- "Why not?" CRNA- "I don't believe in it." I think that pretty much spells it out. One's beliefs are not neccessarily true nor will be defensable in court or to the public. Don't you think the public would demand the use of BIS or a similarproduct if they knew it was available? Anesthesia is saferthan ever, is it because vigilance has improved or is it because our monitoring is more sophisticated?
  13. by   yoga crna
    Dave,
    It is important to understand the legal system and medical malpractice. You have a right to have your own expert witness to atest that your practice was within the standard of care. I have personally testified in an awareness case where the CRNA won. Whether or not she used a BIS monitor was not given any weight by the judge. The fact that the patient misrepresented her current substance abuse was. The facts of each case are different.

    Be careful about being "black and white" about legal issues. The law is predicated on "shades of gray".

    By the way, I have a law degree and would love to have a discourse on this topic.

    Regarding your question on why anesthesia is safer than before, there are probably mulltiple answers, including vigilance, monitoring, education, the legal system, anesthesia agents and techniques. But if I could have one them, I would pick an anesthetist who carefully watches the patient, and is not distracted by being hypnotized by the monitors.

    YogaCRNA JD
  14. by   Tenesma
    yoga... yet again i am confounded by your statement: watches the patient and not hypnotized by monitors!!! i don't mean to pick a fight here, but i find it somewhat confusing...

    first of all there are many situations where you can't watch your patient and all you have are monitors - what do you do then?

    and those monitors are there for a reason: in fact it HAS become a legal issue as the ASA requires certain parameters to be monitored during the case. I don't recall any boxes on my anesthesia sheet that refer to "how does the patient look?"

    you may have been practicing anesthesia for a while, and you may feel very comfortable with the level of anesthesia/the difficulty of patient/etc... from a legal point of view you are still held to the standard of care, and that standard of care is definitely evolving based on new graduates from CRNA/MD programs using new techniques/new equipment, further research, etc... that is why in order to maintain certification we have to take CMEs and take our board exams every so often. Just because you were in an awareness case that was won by the anesthesia provider based on patient misrepresentation doesnt mean anything at all....

    i definitely don't think monitors are the end all - especially since most people don't even know how to interpret the data they see on those monitors - more than enough times i have seen a low saturation displayed on the screen and the anesthesia provider i was with was focusing on readjusting the pulseox on the finger - instead of listening to the lung sounds, etc..

    but trust me, those monitors are your friends, will keep your patient safe and will keep you from writing bigger premium checks to your malpractice insurance company - and over time we will be developing new drugs/new equipment/new padding/new everything that will soon become the standard of care... and i am fully convinced that the BIS or some future generation of it will become a legal requirement for documentation on the chart - just like the oxygen saturation became a requirement in the 70s...

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