Opinions on BIS Monitors?

Kiwi, BSN, RN · Aug 4, 2004

For those of you whose hospitals have integrated BIS Monitors...

Uh-oh :chair:

--> enter Deepz, Kevin, and ?Tenesma?

deepz · Aug 4, 2004

Uh-oh :chair:
--> enter Deepz, Kevin, and ?Tenesma?

---You called, Mahster?

Hey, the BIS is no cure-all, but I like it. Some folks don't. Had a patient today, bouncy as can be, chasing her throughout, trying to match my inhalation % and fentanyl boluses to her needs moment-to-moment as surgical stimulation came and went. Unusually labile patient. For her the BIS was a very handy management tool. Yes, BIS has a lag time delay (averaging) which can be sub-optimal. Yes, some folks still move at incision when their value's a 30 or even less. It's not perfect, it's still quite useful.

deepz

jwk · Aug 4, 2004

:chair: is right

One hospital where I occasionally do some PRN work has them, and they sit unused most of the time.

My main hospital does not / will not use them. Many of the studies supporting their use are questionable. Aspect Medical, which markets the BIS, is the sponsor of much of this research, yet they won't even release information about how the device works or what kind of algorithm goes into determining "the number". I don't know much about EEG's, but supposedly, it's not always possible to tell when a patient is "fully anesthetized" while running a full array on an EEG machine. So how does BIS do this and display one number? They pay a few big-name anesthesiologists to claim that awareness happens 1,000 times a day across the country (one of whom I am very familiar with), and then get on as many news magazine shows and in as many magazines and newspapers as they can to talk about this "epidemic" of awareness, and of course, announce that they have "the cure".

There is a brand new study in this month's Anesthesiology that shows from a cost standpoint that any savings attributed to BIS monitors (less agent, quicker discharge times) are more than offset by the cost of the disposables, meaning using BIS costs more!

There's another study where some crazy German doctors administered NMB's (and nothing else) to each other, with BIS levels dropping into the 40's, yet obviously they were all very wide awake.

My favorite article was out of the ASA Newsletter a few months ago - it was actually a letter to the editor, and the writer suggested that if a certain anesthesiologist's patients experienced awareness at the level he claimed, that perhaps that anesthesiologist should learn another technique.

I think there are now a couple of other devices by other manufacturers on the market that purport to be similar to a BIS monitor. I haven't seen those yet, but I'm sure they're making their appearances at major anesthesia meetings across the country this summer and fall.

I'd like to think that there is some sort of monitor that helps determine awareness, but I don't think we're there yet. I'm certainly far from convinced that the BIS is the answer. In addition, I don't believe the incidence of awareness under anesthesia approaches anywhere near the levels that are often quoted as justification for buying BIS or similar monitors.

sonessrna · Aug 5, 2004

My staff anesthesiologist put it on Jello and got a conscious reading....I say no more!!!

Kiwi, BSN, RN · Aug 5, 2004

My staff anesthesiologist put it on Jello and got a conscious reading....I say no more!!!

:chuckle

Fascinating! Jello is an invertebrate with a CNS!!!!

That raises a couple of ethical questions:

1) Does this mean Jello is alive?

2) If, indeed, it is alive is it humane to eat it while it is still living?

3) In the case of insurgent Jello, will Propofol be enough?!!!!!!!!!!!!!?

sonessrna · Aug 5, 2004

:chuckle
Fascinating! Jello is an invertebrate with a CNS!!!!
That raises a couple of ethical questions:
1) Does this mean Jello is alive?
2) If, indeed, it is alive is it humane to eat it while it is still living?
3) In the case of insurgent Jello, will Propofol be enough?!!!!!!!!!!!!!?

I agree with your ethical dilemnas. Jello cannot be considered alive until it has been jelled for at least 24 hours. To eat it after this time might considered inhumane if the BIS is still connected and giving you a reading of consciousness. Propofol probably will not give you any results, but fruit cocktail may attenuate the sympathetic response.

preCRNA · Aug 5, 2004

:chuckle you guys are hilarious!

I also think that this issue of jello awareness is an epidemic that must be cured. Those poor cups of jello that aren't full anesthetized while "going under the spoon!" Something must be done!

TraumaNurse · Aug 5, 2004

I have a cure for the jello thing. Inject them with vodka or light rum prior to ingestion! It may not make it any more humane, but it can make for a hell of a party!

keermie · Aug 5, 2004

Being that jello is essentially a quad, I believe that a spinal infusion of vodka does remarkably well being that it is able to blunt jello's sympathetic hyper reflexia. Finding the L2-L3 is a bit of a challenge, likened to trying to harpoon a 450 lb. vertebrate. Also of note, the BIS does not account for narcotics in its "interpretation."

sonessrna · Aug 6, 2004

Being that jello is essentially a quad, I believe that a spinal infusion of vodka does remarkably well being that it is able to blunt jello's sympathetic hyper reflexia. Finding the L2-L3 is a bit of a challenge, likened to trying to harpoon a 450 lb. vertebrate. Also of note, the BIS does not account for narcotics in its "interpretation."

If Jello is injected with enough vodka it probably does not need narcotic!

TraumaMaster · Aug 6, 2004

Ya'll are crackin' me up!

We have used the BIS monitors for quite some time and the company has come and had several educational programs for us. However, for most patients, the BIS monitor simply does not work, IMO. Some patients are extremely accurate while others are way off, therefore their reliability is worthless. The company says you must weigh the pain and agitation separately into the "number". Interesting and true as these are different factors. Just needs more accuracy. Just my 2 cents.