Hollywood movie called "awake"

jwk · Mar 7, 2006

JWK is an Anesthesiologist Assistant who is well-respected around here for his clinical knowledge and opinions on all things anesthesia-related, despite the differences the two professions may have. At least, I think so.

Gee thanks.

And SRNA1 - when you start off with "the research states..." it's a red flag in a lot of people's books. Do a search on this board about BIS and you'll find plenty of experienced people that think it's total garbage, and some experienced people who swear by it. There are plenty of good reason's to doubt it's validity. Experience goes a long way in coloring, as well as validating opinions.

Also, you'll soon realize, if you don't already, that substance abuse in anesthesia is a huge problem, and a contributing factor to that problem is the incredible ease with which drugs can be diverted. Sad, but true. And a lot of hospitals are incredibly lax with their narcotic documentation as well.

rn29306 · Mar 7, 2006

Also, you'll soon realize, if you don't already, that substance abuse in anesthesia is a huge problem, and a contributing factor to that problem is the incredible ease with which drugs can be diverted. Sad, but true. And a lot of hospitals are incredibly lax with their narcotic documentation as well.

Overfill on a 5ml vial of fentanyl usually equates to 5.5 - 6.0 mls total. Overfill on a 20 vial of fentanyl is much more.

INTEVA · Mar 8, 2006

I feel the BIS is a helpful tool & should be used. If something does happen during surgery & case goes to court; @ least you have that to back you up; as long as numbers are documented on anesthesia record. You need all the necessary tools available in this day & age.

jwk · Mar 8, 2006

I feel the BIS is a helpful tool & should be used. If something does happen during surgery & case goes to court; @ least you have that to back you up; as long as numbers are documented on anesthesia record. You need all the necessary tools available in this day & age.

But if the numbers are meainingless, what value is it? If your BIS is 40 and your patient quotes your comments made during surgery, you are still screwed.

beachbaby70 · Mar 8, 2006

We still need to use anything available to us. We have 2 pending lawsuits due to awareness; 1 used the BIS & the other didn't. Will keep posted with the outcome.

We have 1 CRNA & 2 anesthesiologists over age 60 that refuse anything new no matter what it is; on the other hand we have 2 anesthesiologists mid 50's that atttend seminars on a regular basis & are willing to try new products for the benefit of the patient.

The older ones feel their experience & knowledge alone is better than any new products. Go figure !!

jwk · Mar 8, 2006

We still need to use anything available to us. We have 2 pending lawsuits due to awareness; 1 used the BIS & the other didn't. Will keep posted with the outcome.
We have 1 CRNA & 2 anesthesiologists over age 60 that refuse anything new no matter what it is; on the other hand we have 2 anesthesiologists mid 50's that atttend seminars on a regular basis & are willing to try new products for the benefit of the patient.
The older ones feel their experience & knowledge alone is better than any new products. Go figure !!

There is NO solid evidence that BIS does what it purports to do. The manufacturer refuses to say exactly HOW it works and how it arrives at a magic BIS number, fully awake volunteers were given a full intubating dose of rocuronium - nothing else - and the BIS indicated they were asleep (the crazy German study) - yada, yada, yada.

And here you have a lawsuit involving awareness where BIS was used. Obviously it didn't help you much.

EKG - proven technology

SaO2 - proven technology

EtCO2 - proven technology

BIS - NOT proven technology and overwhelming unethical sales tactics to practitioners and scare tactics to the general public.

IF, that is IF, a competitor to BIS comes around that can show that it actually works, I would buy ANYTHING BUT BIS. We will NEVER buy any product from Aspect Medical - ever.

athomas91 · Mar 8, 2006

Inteva - JWK is absolutely right...do you really think if it was "proven technology" that it wouldn't be a standard of care...that is not a rational mode of thinking... BIS works according to BIS representatives... there are however multiple, multiple ways to manipulate the data and/or get fake/innaccurate data... not to mention...in court...it has no bearing unless you place a BIS monitor rep on the stand. there are plenty of facilities that don't even own them....

have you used one?

athomas91 · Mar 8, 2006

the place where i am clinically had a whole day of awareness... the des vaporizor wasn't hooked in correctly... how it wasn't noticed on ET monitoring i don't know (perhaps it was before it was used) but ... that is scary.

jwk · Mar 8, 2006

the place where i am clinically had a whole day of awareness... the des vaporizor wasn't hooked in correctly... how it wasn't noticed on ET monitoring i don't know (perhaps it was before it was used) but ... that is scary.

Now THAT would be a real interesting topic for an M&M conference. :eek:

Not fun (if your M&M's were like mine) but interesting.

deepz · Mar 9, 2006

It is utter nonsense to categorically state that BIS 'does not work.'

In my own hands (few thousand cases) and in the vast clinical experience of many others, BIS does work and can be a valuable tool. Empirical evidence -- that's all the proof I need.

Cure-all? No. Insurance against a recall lawsuit? Hell no. Mature technology? Not even close.

But -- valuable clinical tool? Ab-so-lutely.

If this technology weren't promising, then Aspect Medical would not have the companies emerging now to develop their own proprietary brain wave analysis monitors to compete with BIS.

Stayed tuned. This technology has a long way to go yet.

deepz

athomas91 · Mar 9, 2006

deepz - i don't think - at least - i am not saying BIS doesn't work... i just think there are too many ways to invalidate the information which make it impossible to rely on..if i had it - would i use it??? not likely - it is very expensive to use - and if you do your best to provide adequate anesthesia - recall isn't likely ( less than 1% i believe)... now - there are always exceptions - and i am well aware of them... however in those cases - i think that patients should be advised that awareness is more likely and discuss it ahead of time (ie. pregnancy, heart, eyes, trauma) i wonder if they have done a study (that has significant validity both internal and external) to compare the use of BIS in a group as opposed to a group w/o it in high risk settings and if there is a difference in occurances of awareness....

INTEVA · Mar 9, 2006

I'm glad to hear there is someone out there that has something positive to say about the BIS.