"When Anesthesia Fails" on Discovery Health Channel

CougRN · Feb 9, 2005

we just had a lecture on this topic today and if i remember right a recent study found that only 0.13% of surgical patients in the US have reported having recall/awarness. it's an unfortunate thing when it happens but this is a very small percentage of effected people for us to start dictating policy changes for until we know what actually causes awarness.

moosicle · Sep 3, 2005

I am not a CRNA but I understand what you are saying.

Suppose an HIV test gives many inaccurate readings but could detect the disease earlier? Imagine how many people would wait forever to follow up on their false negative! Also, imagine how many people would get very strong drugs to treat a non-existent disease due to a false positive.

Now, imagine that patients demand this test because they want to know now. It would be a horrible experience, much worse than if tried and true methods were used.

I know this is a very different experience but maybe it would make sense to some people who do not understand the importance of accuracy.

I want healthcare professionals to decide the course of my treatments, not another patient. This support group woman can give advice about what to ask but telling you some blanket rule on what healthcare workers should do could be more bad than good.

Let's suppose it accurately detects 1:1000 cases of awareness but also creates a false sense of security in 10:1000 cases. We would be making 9 more people much more vulnerable. I think that is the real debate on this machines accuracy.

Secondly, money has to come from somewhere. Take it from healthcare workers, and imagine how many more occurrences for awareness (or long waits for medical care) would occur because of understaffing! Take it from other programs, and cancer patients may not be treated. The government sure is not planning on helping out.

Every person in here wishes resources were limitless when it comes to healthcare; I think I can safely guarantee that. However, it simply is not the case.

Nitecap · Sep 7, 2005

The BIS is not at all heard to learn, especially if you are an anesthesia provider, you should pick it up quickly. We used them in the ICU that I worked in as a nurse.

I do admit though, sometimes the results are questionable and there is freq interference in the results. The probes sometimes dont fit perfectly, hair may be in the way, or pt may have tiny head. This skews results.

As well as a pt that if edematous and weepy and sweating or has real oily skin or hair. This leas to freq changing of probes that are moderatly expensive.

Plus if pt say has a balloon pump, or surgeon is doing procedure digging and prodding in the chest or abdomen this all causes interference in the results. You still get a numeric value but the interference waves/ bars read high so you still have to use your own judgement. Is the pt really waking or is the machine sensing other things. Even in the ICU we found that a pt with SCD's on had higher values than when without while either no changes in sedation drugs occured or we even gave more sedation. The rep said it was d/t the electrical activity sending sporadic pulses thru the pt. SO if pt's with balloons, vads and on CVVHD the BIS sometimes picked up high levels of interference.

However despite all that I have used the BIS effectively on numerous pt's. Guess just wanted to state that though the BIS is effective its not by any means even close to perfect or precise at that. Hopefully the technology will continue to expand and develope so that one day we can have exact readings representative of whats going on. Until then I guess well just have to think a little and be super asute practitioners. Arent we supposed to be?