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Patient-Specific Drug Titration

Transforming Anesthesia Delivery — One Patient at a Time

Studies have shown reductions in the use of anesthetic drugs by as much as 50% in patients monitored with BIS™ technology:

  • BIS™ monitoring enabled a 50% reduction in propofol administration during hypothermic cardiopulmonary bypass1
  • End-tidal desflurane concentration was reduced by 25% compared with standard anesthesia-monitoring practice2
  • Titration of isoflurane using the BIS™ index decreased use of isoflurane and contributed to faster emergence of elderly patients undergoing elective knee or hip replacement surgery3
  • For asleep-awake craniotomy procedures, where titratable anesthesia is preferred to facilitate more predictable intraoperative wake-up, BIS™ monitoring can provide further information to guide drug administration and predict responsiveness.4

Improved Emergence, Recovery, and Discharge

BIS™ Monitoring — Reliable, Proven

Optimal anaesthetic administration improves patient outcomes and satisfaction, and may facilitate faster recovery and discharge by minimising side effects and postoperative complications. Studies have shown that patients whose anaesthetic dosing was guided by BIS™ monitoring required less anaesthetic drug and experienced:

  • Faster extubation.2,5
  • Faster emergence.5
  • Better orientation at the post-anaesthesia care unit (PACU).5
  • Faster discharge.2,5

BIS™ Monitoring — Reliable, Proven

Studies show an 80% reduction in awareness has been demonstrated when using BIS™ monitoring compared to routine care in both intravenous (TIVA, total intravenous anaesthesia) and inhaled drug combinations in anaesthesia patients.6,7,8

With TIVA procedures, the incidence of awareness can be 5-10 times greater than with inhaled anaesthetics as a result of the short-acting nature of some intravenous anaesthetics used, along with the challenges of monitoring the patient’s level of consciousness. This is all the more reason that BIS™ monitoring is important — it may help reduce the incidence of awareness during TIVA procedures and during inhaled anaesthesia.9

Clinical Evidence

Intraoperative Awareness Prevention

"The prospective studies incorporating BIS™-based protocols provide proof of principal that a brain monitor can be effective in decreasing the incidence of AWR."10

– Author George Mashour, et al., in a clinical review on the prevention of intraoperative awareness with explicit recall.

Improving Anaesthetic Delivery and Postoperative Recovery

"Anaesthesia guided by BIS™ could improve anaesthetic delivery and postoperative recovery from relatively deep anaesthesia."11

– Authors Yodying Punjasawadwong, Aram Phongchiewboon, and Nutchanart Bunchungmongkol, in a clinical review of bispectral index for improving anaesthetic delivery and postoperative recovery.

NICE Guidelines Recommend BIS™ Monitoring

"BIS™ monitoring is recommended as an option for all patients receiving total intravenous anaesthetic (TIVA). BIS™ technology is also cost effective in this patient population due to the inability to measure end-tidal anaesthetic concentration."12

– National Institute for Health and Clinical Excellence

Resources

  • 1. Chiu CL, Ong G, Majid AA. Impact of bispectral index monitoring on propofol administration in patients undergoing cardiopulmonary bypass. Anaesthesia Intensive Care. 2007;35:342-347.
  • 2. White PF, Ma H, Tang J, et al. Does the use of electroencephalographic bispectral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology. 2004;100(4):811-817.
  • 3. Wong J, Song D, Blanshard H, et al. Titration of isoflurane using BIS™ index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anaesth. 2002; 49(1):13-18.
  • 4. Conte V, L’Acqua C, Rotelli S, Stocchetti N. Bispectral index during asleep-awake craniotomies. J Neurosurg Anesthesiol. 2013; 25(3):279-284.
  • 5. Gan TJ, Glass PS, Windor A, et al. Bispectral 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.
  • 6. Zhang, C. Bispectral index monitoring prevents awareness during total intravenous anesthesia: a prospective, randomized, double-blinded, multi-center controlled trial. Chinese Medical Journal. 2011;124(22):3664-3669.
  • 7. Myles PS, Leslie K, McNeil J, et al. Bispectral index monitoring to prevent awareness during anesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363(9423):1757-1763.
  • 8. Ekman A, Lindholm ML, Lennmarken, Sandin R. Reduction in the incidence of awareness using BIS™ monitoring. Acta Anaesthesiol Scand. 2004:48(1):20-26.
  • 9. Sebel PS, Bowdle TA, Ghoneim MM, et al. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg. 2004;99(3):833-839.
  • 10.  Mashour GA, Shanks A, Tremper KK, et al. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: A randomized comparative effectiveness trial. Anesthesiology. 2012;117:717-725.
  • 11. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database of Syst Rev. 2007, Issue 4. Art. No.: CD003843. DOI: 10.1002/14651858.CD003843.pub2.
  • 12. National Institute for Health and Clinical Excellence. Depth of anaesthesia monitors (E-Entropy, BIS™ and Narcotrend) (DG6). November 2012. Available at: http://guidance.nice.org.uk/DG6.
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