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Discussion

Interesting Case

We had an interesting case in the OR last week (well, at least I thought it was interesting).

Patient with a pacemaker scheduled for a posterior C4-5 fusion. Since I know how we handled it... what would be your concerns and how would you handle the case??

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I thought BIS wasn't good for TIVA cases. Haven't used it much to begin with since I don't believe in it (of course that's another thread).

BIS monitors hypnotic anesthetic effects on the brain and therefore, you can use it with TIVA. Sometimes, in teaching student anesthetist, we use the BIS during conscious sedation cases and try to have them keep them in the "sedative" range of 80s.

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In a TIVA, the BIS will monitor agents like propofol but not fentanyl. So depending on what you are using for your TIVA and the ratio . . . interpret your BIS from this rationale. Also, I would not only reprogram the pacer because you will be unable to get a magnet to work in this position all the time; but also increase its intrinsic rate because going prone will often decrease your bp.

QUOTE=skipaway]BIS monitors hypnotic anesthetic effects on the brain and therefore, you can use it with TIVA. Sometimes, in teaching student anesthetist, we use the BIS during conscious sedation cases and try to have them keep them in the "sedative" range of 80s.

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