Bispectral Index™ monitoring
MedEd Bytes
MedEd Bytes series:
MedEd Bytes is a video series that offers a quick and digestible learning format that can help solidify your understanding of different therapies leveraged in patient monitoring and respiratory interventions. In this series, we’ll cover topics such as capnography waveforms, the technology behind pulse oximetry, modes of ventilation, and more. To stay up to date with the series, please subscribe to our YouTube channel or start watching the series below.
Bispectral Index™ monitoring
The Bispectral Index (BIS™) monitor is primarily used to measure anesthetic depth for general anesthesia.1–4 Anesthesia that is too light can lead to intraoperative awareness with recall, whereas anesthesia that is too deep is associated with adverse short-term outcomes like delayed emergence, and adverse long-term outcomes postoperative cognitive dysfunction at 12 weeks.5,6
In this MedEd Bytes series, we learn about the application of BIS™ monitoring to ensure adequate depth of anesthesia for a patient under general anesthesia.
Byte 1: When to use BIS™ monitoring
The BIS™ monitor allows practitioners to safely titrate the delivery of total IV anesthesia or volatile-based general anesthesia to the appropriate depth for the patient.5,7
02:11
YouTube
Byte 2: The BIS™ index range
The BIS™ index is a unitless measure of brain activity that is calculated by an algorithm. This algorithm was developed through the interpretation of a vast quantity of empirical data of patients under general anesthesia.
02:24
YouTube
Byte 3: BIS™ monitoring system benefits: awareness/recall prevention
The BIS™ monitor was designed to monitor brain activity with the specific goal of identifying the depth of anesthesia that will prevent intraoperative awareness and recall.
02:03
YouTube
Byte 4: BIS™ monitoring system benefits: PONV reduction
The use of propofol instead of inhalational anesthetics can reduce PONV and using EEG monitoring such as BIS™ monitoring provides the ability to consistently monitor anesthetic depth while doing so.7,8
02:22
YouTube
Byte 5: BIS™ monitoring system benefits: avoiding overdose
Using a BIS™ monitor not only helps guide practitioners to avoid underdosing anesthesia, but also to avoid overdosing and its associated adverse outcomes.6,9–11
02:00
YouTube
Byte 6: BIS™ monitoring use in resident and fellow training
The American Society for Enhanced Recovery and Perioperative Quality Initiative’s consensus statement provides a strong recommendation that clinicians be knowledgeable in electroencephalography, or EEG interpretation.12
01:54
YouTube
Byte 7: Intravenous anesthesia and greenhouse gasses
Because of the contribution that volatile agents make to the greenhouse gas effect, it has been hypothesized that the use of TIVA would reduce the environmental impact of anesthesia.13
02:08
YouTube
Byte 8: How BIS™ monitoring helps achieve anesthetic goals
The BIS™ monitor provides a straightforward index which measures the actual clinical effects that anesthetic agents exert on a patient’s consciousness.
02:12
YouTube
Byte 9: Why measure anesthetic effect with the BIS™ monitor?
The use of a BIS™ monitor has been demonstrated to reduce the incidence of intraoperative awareness with recall.5
02:27
YouTube
Byte 10: ERAS society guidelines: strong recommendation for depth of anesthesia monitoring
The American Society of Enhanced Recovery strongly recommends monitoring processed EEG, like what BIS™ monitor provides, during surgery whenever TIVA is used in order to reduce the risk of intraoperative awareness with recall.12
02:06
YouTube
Byte 11: BIS™ monitoring in elderly patients
The BIS™ monitor allows practitioners to safely titrate the delivery of total IV anesthesia or volatile-based general anesthesia to the appropriate depth for the patient.5,7
02:21
YouTube
Byte 12: Breakdown of an EEG waveform
Decades of empirical research have revealed that specific patterns on EEG correspond with specific states of the brain.
02:15
YouTube
Byte 13: EEG waveform interpretation
With enough practice, anesthesia providers can identify which EEG waveforms are associated with high and lower levels of consciousness.
02:15
YouTube
Byte 14: DSA overview
An arguably easier way to assess EEG activity over time is by reading a special type of display called a density spectral array.
02:16
YouTube
Byte 15: DSA drug signatures
The administration of specific anesthetic agents is associated with very specific patterns that emerge on a density spectral array.
02:17
YouTube