BIS™ for Enhanced Recovery After Surgery

Enhanced Recovery After Surgery is an evidence-based trend that provides multiple guidelines to help maximize patients’ health and optimize outcomes. Many anesthesia society guidelines and recommendations recommend using anesthetic depth monitoring, namely Bispectral Index™ monitoring, to avoid complications associated with too much or too little anesthesia.

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Enhanced Recovery After Surgery associated improved outcomes include:

Shorter length of stay²
Fewer complications²
Earlier return of gastrointestinal function²
Reduced costs²
Lower incidence of postoperative delirium³
All without higher readmission or mortality rates²

BIS™ monitoring reflects the anesthetic effect on your patient’s brain, empowering you to personalize dosing that improves patient postoperative outcomes.⁴

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A circular illustration representing 38 percent

Reduce primary anesthetic delivery by as much as 38%^4-8

A circular illustration representing 87 percent

Patients monitored with BIS™ technology are more fully awake and oriented upon arrival in the PACU and ready for discharge faster^4,8

A circular illustration representing 29 percent

Reduce postoperative delirium by up to 29% for better patient outcomes^9,10

Helps you optimize dosing for each patient^3,11,12
Helps you reduce postoperative delirium for better patient outcomes^3,9,11

Faster patient throughput due to using less anesthesia which helps reduce recovery time in the OR and PACU²
Faster discharge from the PACU helps minimize OR delays²

Clinical Evidence

“BIS™ monitoring of anaesthetic depth should be considered where ETAG (end tidal anesthetic gas) monitoring is not employed.”¹³

- Erik Stenberg et al, Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS™) Society Recommendations: A 2021 Update

“BIS™ monitoring-guided anesthesia is recommended to reduce the amount of anesthesia used and hasten awakening.”¹⁴

- Gregg Nelson, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS™) Society recommendations — 2019 update

“The use of BIS™ or newer burst suppression monitoring to avoid overdose of anesthesia in the elderly may have a role in reducing the risk of postoperative delirium and postoperative cognitive dysfunction in this patient population.”¹⁵

- Ulf Gustafsson et al., Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS™) Society Recommendations: 2018

Educational Opportunities

Access training portal

Brain monitoring training pathways

Listen to MedEd podcast

Interview-style discussions on anesthesia and the brain

Check MedEd Bytes

A “byte”-sized educational video series

Watch webinars

A library of brain monitoring webinars

Disclaimer: The BIS™ monitoring system* should not be used as the sole basis for diagnosis or therapy and is intended only as an adjunct in patient assessment. Reliance on the BIS™ monitoring system alone for intraoperative anesthetic management is not recommended.
*Licenced as EEG COMPLETE MONITORING SYSTEM
™* Third-party brands are trademarks of their respective owners.
1. ERAS™* Society guidelines. Published 2023.
2. Lau CSM, Chamberlain RS. Enhanced recovery after surgery programs improve patient outcomes and recovery: A meta-analysis. World J Surg. 2017;41: 899–913. doi: 10.1007/s00268-016-3807-4.
3. Sanders R, Pandharipande P, Davidson A, et al. Anticipating and managing postoperative delirium and cognitive decline in adults. BMJ. 2011; 343:d4331.
4. Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD003843. DOI: 10.1002/14651858.CD003843.pub4.
5. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2014;(6):CD003843. doi:10.1002/14651858.CD003843.pub3.
6. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology. 1997;87(4):842-848.
7. Luginbühl M, Wüthrich S, Petersen‐Felix S, Zbinden AM, Schnider TW. Different benefit of bispectal index (BIS™) in desflurane and propofol anesthesia. Acta Anaesthesiologica Scandinavica. 2003 Feb;47(2):165-73
8. Gan TJ, Glass PS, Windsor A, et al. BIS™pectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS™ Utility Study Group. Anesthesiology. 1997;87(4):808-815.
9. Punjasawadwong Y, Chau-in W, Laopaiboon M, Punjasawadwong S, Pin-on P. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non-neurosurgical procedures in adults. Cochrane Database of Systematic Reviews 2018, Issue 5. Art. No.: CD011283. DOI: 10.1002/14651858.CD011283.pub2.
10. Chan MT, Cheng BC, Lee TM, Gin T; CODA Trial Group. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. Neurosurg Anesthesiol. 2013 Jan; 25(1), 33–42.
11. Whitlock E, Vannucci A, Avidan M. Postoperative Delirium. Minerva Anestesiol. 2011 April; 77(4): 448–456.
12. Zywiel MG, Hurley RT, Perruccio AV, et al. Health economic implications of perioperative delirium in older patients after surgery for a fragility hip fracture. J Bone Joint Surg Am. 2015; 97(10):829–836.
13. Stenberg E, Dos Reis Falcão LF, O’Kane M, et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations: A 2021 Update [published online ahead of print, 2022 Jan 4]. World J Surg. 2022;10.1007/s00268-021-06394-9. doi:10.1007/s00268-021-06394-9.
14. Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer. 2019;29(4):651-668. doi:10.1136/ijgc-2019-000356.
15. Gustafsson UO, Scott MJ, Hubner M, et al. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS®) Society Recommendations: 2018. World J Surg. 2019;43(3):659-695. doi:10.1007/s00268-018-4844-y.

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BIS™ monitoring for Enhanced Recovery After Surgery

Evidence-based practice.

Why anesthetic depth monitoring?

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Benefits of bispectral index monitoring

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BIS™ technology is part of Enhanced Recovery After Surgery guidelines