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Product&therapy spiclest Wael Nasri 1

BIS monitoring provides additional information for the

anesthesia provider by directly measuring the effects of anesthesia on your patient.

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Overview of the TechnologyDemonstrated BenefitsClinical Applications & Special Considerations

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Key points to remember “Remember Red”

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BIS BackgroundTraditional Measures for Anesthesia Titration

BIS Range Guidelines

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10+ years development cycleFirst to market a direct measure of

anesthetic effectStatistically derived from EEGLinear across EEG statesCorrelated with hypnotic endpointsPatient / drug independent

Rampil, I, Anesthesiology, Oct. 1998. Wael Nasri 6

Designed for the anesthesia providerEase of Sensor Application Processing Speed + Data presentation

Measures the effects of anesthetics in the brainEndpoint: hypnosis / consciousnessPatient & drug* independentNo calibration or baseline

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Hemodynamic ResponsesEnd Tidal Agent MonitoringExpectations of Standard Dosages

Healthy Middle Aged MalesVariance in Metabolic & Clearance of DrugsEffects of Combined Drugs

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Balance of Anesthesia

Analgesia Muscle Relaxation

Consciousness / HypnosisBIS

Train of FourAutonomic & Somatic Responses Wael Nasri 9

BIS

100

70

60

40

0

HYPNOTIC STATE

AWAKE / LIGHT TO MODERATE SEDATION

LIGHT HYPNOTIC STATE

Low Probability of Explicit Recall <70

MODERATE HYPNOTIC STATE

Low Probability of Consciousness <60

DEEP HYPNOTIC STATEEEG SUPPRESSIONWael Nasri 10

Less drug utilization Faster wake-up and extubation More alert and oriented patients in

PACUEarlier discharge from PACU Facilitates PACU Phase I bypassReduced PONVMonitor for risk of awareness

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A Propofol

B Propofol

C Sevoflurane

D Desflurane

E Isoflurane

F Isoflurane

G Isoflurane

H Isoflurane

I Propofol

Reduction in Amount of AnestheticUsed in BIS Monitored Group

Ineffective: Recall Inadequate Anesthesia

Excessive: Cardiovascular Effects Prolonged Emergence Recovery Increased Drug Use $

AWAKE

FLAT LINE EEG

Optimal DepthOptimal Depthof Unconsciousnessof Unconsciousness

BIS

IN

DE

X

Awake

Light/Moderate Sedation

Deep Sedation

General Anesthesia

Deep Hypnotic State

Flat Line EEG

70

60

40

0

100

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50

60

70

80

PRE BIS POST BIS

•Length of PACU StayLength of PACU Stay

BIS Patients Discharged 16% Faster

•N=2659N=2659 •N=2505N=2505

0

2

4

6

8

Prior to BIS Use BIS Use

PO

NV

% 6.2%

2.8%

PONV reduced>50% when BIS wasused in ambulatoryanesthesia

Intraoperative patient assessmentPatient-based titration of anesthetic agents

Reduces anesthetic drug utilization Improves specificity of drug selection

Perioperative ImprovementsFaster, more consistent emergence / extubationHigher-quality recovery / more alert patients

Effective monitor for the risk of awareness

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BIS Applicable CasesSpecial Considerations

Sensor PlacementArtifactsPatient Movement

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General Surgery Cardiac Surgery Out Patient Surgery MAC with Sedation

Special Procedures ICU Patients

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Adoption Profile (“Learning Curve”)20-30 cases: Concept, Confidence, Clinical ToolReflect, not Direct, Anesthesia Care

The BIS Monitor doesn’t improve the anesthetic course / recovery doesn’t “prevent” awareness

The BIS Monitor Provides new information / perspective

Interpretation, Assessment Anesthesia Plan Agents, Doses, Timing

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Sensor acquisition Signal Quality EMG / Artifacts Patient Movement Analgesic Vs. Hypnotic State

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Most critical component of system!

Dual-position versatility

right or left application

Peel-place- and-press convenience

Designed to fit any adult patient

Single point monitor connection

Apply sensor on forehead at angle Circle #1: Centered, 2 inches above

nose Circle #4: Above/Adjacent to eyebrow Circle #3: Either temple between corner

of eye and hairline

Press edges of sensor Circle all 4 elements

Press each circle for 5 seconds Use fingertip Press firmly

2 Inches

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Indicates quality of EEG signalDisplayed from 0 - 100%% of good data throughout prior 60

secondsAveraged information

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What are they?signals generated from sources other than the

patient’s EEGexamples: bovie or noise from unshielded

equipmentBIS usually filters these out

examples: eye blinks, eye movement

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Arises from muscle activityMore prominent as patient lightens from

anesthesiaEMG may bias the BIS to a higher value

Could be artifact or real - indicates need for troubleshooting

Increasing analgesic and/or hypnotic can reduce EMG

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Patient Movement Analgesic Vs. Hypnotic State

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BRAINConsciousnessMemory Function

SPINAL CORDReflex MovementAnalgesia

Eger, et al. Anesth Analg 1997;84:915-8

Dose-Response

Drug-Drug Interactions

Patient-Surgery-Response

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BIS is not an anesthetic depth measureInformation about your patient to help in

your clinical decision-making processUse in conjunction with traditional

monitoringReliance on the BIS alone for

intraoperative anesthetic management is not recommended

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More PatientsMore BISMore Confidence

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