"When Anesthesia Fails" on Discovery Health Channel

jwk · Feb 7, 2005

I've just started seeing the BIS, or "consciousness monitoring forehead thingy" :chuckle, lately (I'm in the PACU.) It interests me and I'd like to here some anesthetist's prespectives on it. Is it basically just a really limited EEG (BIS is to EEG as tele box is to 12-lead, maybe?) Or something completely different? I'd be interested to know.

Do a search and you'll find more than you want to know about both BIS and awareness in anesthesia (including looking back on this thread)

apaisRN, RN, CRNA · Feb 7, 2005

http://www.anesthesiaawareness.com/

This website sounds like it might be unfriendly to CRNAs. There's a comment in the FAQ about whether the patient knows if the anesthetist is an MD or a CRNA. Makes it sound like the first option is superior. I wish people would get educated and not write junk like that. She could have written "the patient has no knowledge of the anesthesia provider's credentials."

jacads · Feb 7, 2005

Can we please stop beating this dead horse about the BIS monitors? This thread seems to appear about every 3-4 months or so.

jwk · Feb 8, 2005

can we please stop beating this dead horse about the bis monitors? this thread seems to appear about every 3-4 months or so.

it's all one big long thread dating back to 2003. no one is forcing you to read it.

this is the first time i've actually seen a reference to www.anesthesiaawareness.com. although i don't doubt this lady's sincerity and believe that she in fact did experience awareness under anesthesia, this website is pretty scary from an anesthesia professional's standpoint, whether md, crna, or aa. she's now developed it into a cottage industry - check out this from the website:

ms. weihrer is available on a consultant basis to discuss how best to meet the jcaho's recommendations.

she is offering a 1-day program which includes as many speeches as needed to cover sensitizing your entire staff to the full effects of awareness, packets for all speech attendees; and the rest of day spent with hospital administrators and department heads going bullet by bullet through the jcaho recommendations and how and why they must be implemented. for those who schedule before the ad in outpatient magazine appears, the cost will be $750 plus expenses. after the december issue is distributed, the price will be $1,000.

it's one thing to let people know that you think there is a problem. it's another thing entirely to be a pest about it, and then profit from it. now that she is charging speakers fees, her credibility is undermined as well, kind of like the docs who stump for aspect. let's face it - their credibility is certainly shot. it's a blatant conflict of interest all around.

let real medical research take a look at the problem. give researcher's time to investigate the true causes and incidence of awareness in anesthesia, not just some wild claim that it's 1 in a 1000. it simply isn't. give them time to figure out if bis claims to do what it does (doesn't sound convincing so far), or if other monitors might do a better job (promising). it's not like no one cares and no one is studying the issue - there are hundreds of studies being done. my prediction? most of the cases of true anesthesia awareness (excepting trauma, emergency c-sections, and cardiac) will be found to be due to 1) carelessness (e.g. empty vaporizer) or 2) substance abuse/drug diversion by the anesthesia provider, neither of which problems will be solved by bis or any other monitor.

whining to the president of the asa is not going to help anything. has she even asked the aana president? (just curious) obviously someone has gotten to jcaho (does $$$ talk at jcaho?) just a question, not an accusation - one has to wonder how jcaho gets involved in a "problem" that the experts in the field haven't even formed a consensus on yet.

affected · Feb 9, 2005

Any of you who doubt Mrs. Weiher's knowledge of this subject, think she is being a pest, or think she is doing all of this for profit....you could not be more WRONG!!

She may not be of the medical field, but she is a Godsend to thousands of people like me and cuddiebear.

As far as beating the dead horse with the BIS monitor, if you or anyone you loved had experienced such a nightmare, you may rest a little easier to know that there is something out there that may prevent this from happening to anyone else.

kmchugh · Feb 9, 2005

First of all, a huge ditto to everything JWK said. It is one thing to raise awareness of a problem, it is another thing entirely to profit from the problem.

Next, for Affected. I have no doubt that Mrs Weiher has been a huge help to you and others like you. No one here is doubting that, neither is anyone here saying that awareness under anesthesia does not happen. However, do not believe that the BIS monitor is the final answer. It isn't. Everyone of us who does anesthesia for a living has either seen or knows of people who have seen the BIS monitor give some pretty funny readings. For example, I have actually had a conversation with a patient the BIS monitor was telling me was sound asleep. And yes, all the leads were firmly and correctly attached to the patient. A friend of mine related putting the BIS monitor on an inanimate object (an OR table?) and getting a reading telling him that the object was awake.

Go way back in this thread to my first post. Look at what the actual statistics are. I am truly sorry for the experiences that you and others have had, but don't believe everything that Aspect is telling you about their monitor being the answer to the problem. I actually worry that Aspect is using you, and people like you, and the emotional and physical pain you have suffered to increase corporate profits. And I fear that they are not being entirely honest with you.

The BIS monitor is a good monitor, for some procedures. I've used it. But I don't use it for all cases. It isn't the end all for monitoring patient awareness. It isn't the next "pulse oximeter" Aspect is hoping it will be. What it is, though is a very expensive monitor, that if used for every case, will serve to drive up the cost of anesthesia with little or no benefit.

Kevin McHugh

athomas91 · Feb 9, 2005

just a note....

i think it is also important to realize the differences in anesthesia....some types of anesthesia -- you WILL HEAR, you WILL REMEMBER... they are meant that way and i find many patients getting this confused with recall...

i have had at least 5 pts in the last year telling me about their "recall" when it was a MAC/local, MAC or spinal - they are alarmed that they remembered conversations but weren't able to talk etc due to what was likely deep sedation...

just a thought.

affected · Feb 9, 2005

Let me start with saying, you can not judge someone until you have met them or at least spoke with them. Mrs. Weiher has contributed her time and her own money to raise awareness in the medical field and to let victims of anesthesia awareness know that NO they are not crazy, nor are they alone.

Secondly, I am not thinking that the BIS monitor is the answer, but if it can prevent at least 1 out of 1000 people from experiencing such agony, then it should be used during EVERY surgey conducted at EVERY hospital, no matter the cost! Cost should not be an issue with any tool that could prevent at least one persons whole life from being totally disrupted by such an experience.

First of all, a huge ditto to everything JWK said. It is one thing to raise awareness of a problem, it is another thing entirely to profit from the problem.
Next, for Affected. I have no doubt that Mrs Weiher has been a huge help to you and others like you. No one here is doubting that, neither is anyone here saying that awareness under anesthesia does not happen. However, do not believe that the BIS monitor is the final answer. It isn't. Everyone of us who does anesthesia for a living has either seen or knows of people who have seen the BIS monitor give some pretty funny readings. For example, I have actually had a conversation with a patient the BIS monitor was telling me was sound asleep. And yes, all the leads were firmly and correctly attached to the patient. A friend of mine related putting the BIS monitor on an inanimate object (an OR table?) and getting a reading telling him that the object was awake.
Go way back in this thread to my first post. Look at what the actual statistics are. I am truly sorry for the experiences that you and others have had, but don't believe everything that Aspect is telling you about their monitor being the answer to the problem. I actually worry that Aspect is using you, and people like you, and the emotional and physical pain you have suffered to increase corporate profits. And I fear that they are not being entirely honest with you.
The BIS monitor is a good monitor, for some procedures. I've used it. But I don't use it for all cases. It isn't the end all for monitoring patient awareness. It isn't the next "pulse oximeter" Aspect is hoping it will be. What it is, though is a very expensive monitor, that if used for every case, will serve to drive up the cost of anesthesia with little or no benefit.
Kevin McHugh

athomas91 · Feb 9, 2005

affected -

that is what they are trying to say - there IS no guaratee that it will prevent even 1:1000 people from having recall - BIS comes with absolutely no guarantees - and that could even give a false sense of security and make the problem worse...

and i don't think anyone was judging this lady - everyone posted very heartfelt empathy for what she and anyone who has recall goes through....but if your motivation is to prevent it and support others - why the "admission" price?? that is a viable concern - not a judgement. the profession of anesthesia is concerned about awareness - and does all it can to protect patients - but as ALL nurses should know - medicine nor nursing is 100% all the time - yes, there is human error - but there is also the unknown that cannot be avoided even with all possible precautions. in the grand scheme of things - the incidence of awareness is very low - i am not discounting how horrible it is for those who have to go through it - but i think it more shows how many precautions we do take and that are successful. surgery comes with risk - infection, death, and yes - recall....nothing, medically or otherwise speaking, is 100% all the time.

apaisRN, RN, CRNA · Feb 9, 2005

i think it is also important to realize the differences in anesthesia....some types of anesthesia -- you WILL HEAR, you WILL REMEMBER... they are meant that way and i find many patients getting this confused with recall...
i have had at least 5 pts in the last year telling me about their "recall" when it was a MAC/local, MAC or spinal - they are alarmed that they remembered conversations but weren't able to talk etc due to what was likely deep sedation...

Interesting. People frequently don't understand the nature of their anesthesia/analgesia beforehand? (why am I even asking?) Hearing things during the surgery may be disturbing, especially if it wasn't intended, but it is nothing like actually experiencing the incision and procedure with full sensation. I wonder if the statistics about awareness include some patients who had hearing, whether intended or not, but no pain.

deepz · Feb 9, 2005

.......Cost should not be an issue with any tool that could prevent at least one persons whole life from being totally disrupted by such an experience.

Sorry, that just is not realistic. Cost, unfortunately, will always be an issue. Cost/benefit tradeoffs enter into many things in medicine and anesthesia as we practice in the everyday world. Just the facts.

deepz

jwk · Feb 9, 2005

... but if it can prevent at least 1 out of 1000 people from experiencing such agony, then it should be used during EVERY surgey conducted at EVERY hospital, no matter the cost! Cost should not be an issue with any tool that could prevent at least one persons whole life from being totally disrupted by such an experience.

And this is where your argument falls apart. Cost MUST be a consideration in all we do. You are not a medical professional. If you were, you would have a better understanding of this issue. Hospitals are squeezed now with medical costs. Where do you think this money comes from? Someone has to pay for it. You can't have high-cost medical care at bargain basement prices. You think that $15 copay at the doctor's office pays for everything? Nope.

Do you know how much a BIS monitor costs? Do you know how much the DISPOSABLE probe costs per patient? Do you know how much time is involved in training people to use it? Do you know what the maintenance costs are involved with the machine?

And perhaps most important - DOES IT EVEN WORK? Does it even do what it purports to do? Because if it doesn't, then it's WORTHLESS. You and Ms. Weiher don't seem to be concerned with that. Anything is better than nothing, right? NO! It doesn't work like that. We simply can't afford to use unproven technology. My hospital does almost 40,000 procedures per year. We're talking MILLIONS of dollars per year for something that simply doesn't happen anywhere close to the 1:1,000 Aspect Medical would like everyone to believe. At that rate, we would have almost a case per week of anesthesia awareness. It just doesn't happen like that!!!!! We don't have millions of dollars to waste on something that has not been proven to do what the manufacturer says it can do.

All that being said, I'm sure I won't change your mind, because YOU DON'T CARE HOW MUCH IT COSTS. It doesn't matter to you if it's $100 per patient or $1000 or $10,000. You see a problem and are willing to grab at any solution, even a bad one, in the hopes that it will solve the problem. I will tell you what will change my mind - real scientific evidence that ANY awareness monitor purports to do what it says, offered by someone besides those funded by the equipment manufacturers. Do you really think that there is ANY anesthesia provider out there who WANTS their patients to have awareness under general anesthesia? Of course not. We just want to know that something works before we use it.

Pulse oximetry works. Period. End tidal CO2 monitoring works. Period. EKG monitoring works. Period. BIS or other awareness monitors? Don't know YET. But when I see studies that show fully awake volunteers to be fully anesthetized according to the BIS monitor, I wonder whether it works or not. Can you not see that point?