Using bispectral index monitoring to gauge depth of. The bispectral index bis monitor is a passive analyzer of eeg that provides surrogated measures of the hypnotic level. The use of the bispectral index in the detection of pain in mechanically ventilated adults in the intensive care unit. In 1980, the scope of practice statement was first published as part of the american association of nurse anesthetists guidelines.
Does monitoring bispectral index or spectral entropy reduce. It is fair to say that at the moment the bispectral index bis does not offer guarantees for awareness prevention and as reported by avidan, the use of the bispectral index could give anesthesiologists a false sense of security that if they keep the measurement between 40 and 60, they will prevent anesthesia a. A computer search of englishlanguage articles in medline 196. It is derived utilizing a composite of measures from eeg signal processing techniques including bispectral analysis, power spectral analysis, and. Comparison between dexmedetomidine and propofol with. Overall correlation between the bispectral and the patient state indices was 0. Intraoperative use of bispectral index monitoring and time. Documents depth of anaesthesia monitors bispectral. Nice is aware that the association of anaesthetists of great britain and ireland aagbi has updated its recommendations for standards of monitoring during anaesthesia and recovery since the publication of diagnostics guidance 6. Name of blue advantage policy bispectral index monitoring. Results overall correlation between the bispectral and the patient state indices was 0. Bis index as postarrest monitor bis measurement is most reliable neuroprognosticator at. Intraoperative use of bispectral index monitoring and.
Bispectral index monitor ontario healthtechnology assessment series 2004. The objective of the study is to determine wether the use of the bispectral index monitor bis as a method to guide anaesthesia for children in different groups of age, undergoing ear nose and throat surgery anaesthetized with an infusion of propofol and remifentanil with an high dose of remifentanil 0,52 mcgkgmin, can lead to a reduction in the time needed for extubation and. Using bispectral index monitoring to gauge depth of sedation. Aspect medical systems, newton, ma uses the bispectral analysis of the eeg, while the entropy module ge healthcare, helsinki, finland, based upon spectral entropy, describes the irregularity, complexity, or unpredictability characteristics of a signal. Evidencebased recommendations on the bispectral index bis, eentropy and narcotrendcompact m depth of anaesthesia monitors. Time course of the bispectral index bis of volunteer mm in the second experiment. Bispectral index bis on ventilated patients in the. Bispectral index monitoring is a useful tool to accomplish this, because it can provide objective information as to the degree of sedation in these critically injured patients. Does monitoring bispectral index or spectral entropy. Validation of the bispectral index monitor for measuring the depth of sedation in children senthilkumar sadhasivam, md, arjunan ganesh, mbbs, amy robison, ba, robin kaye, md, and mehernoor f.
Bispectral index monitoring documents burst suppression. It is a weighted sum of several electroencephalographic subparameters, including a time domain, frequency domain, and high order spectral subparameters. The depth of sedation is calculated by measuring cerebral electric activity via an electroencephalogram eeg. Time course of the bispectral index bis of volunteer ub. Depth of anaesthesia monitors bispectral index bis, e. The bispectral index bis is a multifactorial parameter derived from the electroencephalogram eeg, which allows monitoring of the hypnotic component of anesthesia. Aspect bis vista service information manual pdf download.
Today, the bis index remains the most validated form of consciousness or brain function monitoring used within the clinical context of anesthesia and sedation care. When the bispectral index bis can give false results. The aim of this metaanalysis of observational studies was to examine the potential association between depth of anesthesia. Bis view monitoring system franks hospital workshop. To provide rigorous data on the neurocognitive outcomes associated with bisguided anesthesia, we conducted a randomized controlled trial of bisguided anesthesia vs standard anesthesia care using concentrationguided techniques. The bis monitor reports a single number from 0 to 100 that represents an integrated measure of cerebral electrical activity. Pdf role of the bispectral index in sedation monitoring in. Bis monitors are noninvasive devices that reflect a signalprocessed eeg. Bispectral index bis on ventilated patients in the prehospital setting ohbis the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A computer search of englishlanguage articles in medline 1966july 2005.
Bispectral index bis is a dimensionless variable between 0 and 100 that correlates with the degree of sedation 14. In edition, the envoy provides long term storage and display of the bis index and its related parameters as numeric charts and graphic trends. Bispectral index article about bispectral index by the. The bispectral index declines during neuromuscular block. The cerebral cortex is characterized by a rich network of neurons, particularly pyramidal cells, generating millions of small current loops that can be detected as the electroencephalogram eeg. Bispectral index bis monitoring level of consciousness with the. Intraoperative use of bispectral index monitoring and time to extubation and patients length of stay after cardio pulmonary bypass surgery, at annajah national university hospital nablus palestine. Bispectral index score and observers assessment of awarenesssedation. Bispectral index monitoring basics article nursingcenter. Overview depth of anaesthesia monitors bispectral index. The bis monitor provides a single dimensionless number, which ranges from 0 equivalent to eeg silence to 100. The bis view system processes raw eeg signals to produce a single number, called the bispectral index, or bis, which correlates with the patients level of.
Bispectral index monitor ontario health technology assessment series 2004. A bispectral index bis monitor is commonly utilized to assess depth of sedation when administering sedative, hypnotic, or anesthetic agents during surgical and medical procedures. The association between anesthesia depth and mortality is still controversial. It is derived utilizing a composite of measures from eeg signal processing techniques including bispectral analysis, power spectral analysis, and time domain analysis. The monitor is menudriven with fixed keys for choosing the options available. The percentage of bispectral index values in the recommended range for general anaesthesia 4560 that were confirmed by levels of patient state index 2550 was calculated and vice versa.
Bispectral index bis has been used in adults to measure depth of anesthesia using various protocols. Listing a study does not mean it has been evaluated by the u. Continuous graphic trend of the bis index and quality parameters are also available on the screen under the label crg. Bis allows hypnotic titration over the complete range of. Mar 30, 2017 the association between anesthesia depth and mortality is still controversial.
Bispectral index bis monitoring systems allow anesthesia professionals the ability to access processed eeg information as a measure of the effect of certain anesthetics during the care of patients they select to monitor. Philips bispectral index bis measurement uses aspect medical. There were 75 patients enrolled in a sixmonth period using the observers assessment of alertnesssedation and the continuum of depth of sedation scales. The bispectral index declines during neuromuscular block in. A randomized controlled trial of anesthesia guided by. Abella, md, mphil clinical research director center for resuscitation science department of emergency medicine. Abdulhamid samarkandi abstract background and goal of study. The bis view monitoring system is a userconfigurable patient monitoring system designed to monitor the hypnotic state of the brain based on acquisition and processing of eeg signals. Bispectral index monitoring and intraoperative awareness. Called the bispectral index bis monitor, this noninvasive device can be used without assistance from highly specialized clinicians. It operates from an ac power source of 100v to 240v, 4763hz, and provides a minimum 20 minutes of automatic backup battery power. Electroencephalogram and bispectral index monitoring. Bispectral analysis is a method of analyzing the mathematical relationships among the various components of an eeg signal phase couplings as well as.
Results from volunteer studies demonstrate that bis correlates well with clinical assessments of sedation induced by sedativehypnotic drugs. Evidence in the literature documents patient benefits in the. The aim of this metaanalysis of observational studies was to examine the potential association between depth of anesthesia as a low bispectral index bis and mortality. The real time eeg signal is continuous y displayed on the monitor screen. Oct, 2015 bispectral index is one of several technologies used to monitor depth of anesthesia. Nov 21, 2012 the monitors are bispectral index bis, e. The bispectral index bis is a processed electroencephalogram eeg monitor that measures the hypnotic effects of anesthetics and sedatives. This article explains how bis monitoring works and describes the authors experience with bis monitoring in patients undergoing elective synchronized electrical cardioversion. The present study evaluates the ability of bis and psi to separate unconscious from conscious patients and. Bispectral index bis values are generated from an empirically derived algorithm and are meant to re.
For additional informationand supporting documents, see. Role of the bispectral index in sedation monitoring in the. The bispectral index bis helps in the assessment of the depth of hypnosis. Use of bispectral index bis for monitoring of total. The bispectral index is a statistically based, empirically derived complex parameter. Page 1 service information manual aspect medical systems, inc. Bispectral index monitoring gives objective and reliable data where the nurse can base care from, instead of relying mainly from vital signs as well as subjective signs, and thus, pose lesser threats of both undersedation and oversedation. Use of the bispectral index bis, developed from a processed electroencephalog.
Bispectral index legal definition of bispectral index. Bispectral index monitoring in ischemichypoxic brain injury. Ssep is an underutilized modality somatosensory evoked potential ssep n20 response at 72 hours relatively strong predictor of outcome. Bispectral index bis monitoring standard of practice icu indications for use. Bispectral index bis varying strength of data for each modality. Subjects were randomly assigned to a bispectral index bisguided. It would be a great advantage if bis permitted a more rapid recovery and less consumption in morbidly obese patients with a high cost inhaled agent. Bis allows hypnotic titration over the complete range of cortical activity 2. Bispectral index monitoring an overview sciencedirect topics. To validate the sedationagitation scale sas with the visual analog scale vas and bispectral index bis in adult icu patients after cardiac surgery. The bis values in children undergoing routine general anesthesia with a variety of iv and inhaled anesthetics were reported to be comparable to those reported in adult controls10. The sensitivity and specificity of a bispectral index value of 10 to 20 were 96% and 92%, respectively, whereas the sensitivity and specificity of a suppression ratio of 65% to 85% were 89% and 88%, respectively, in demonstrating the presence of 3 to 5 burstsmin. Comparison between dexmedetomidine and propofol with validation of bispectral index for sedation in mechanically ventilated intensive care patients bharat paliwal1, pyush rai2, manoj kamal3, geeta singariya4, madhu singhal5, priyanka gupta6, tanuja trivedi7, dilip singh chouhan8.
Documents depth of anaesthesia monitors bispectral index. The conclusion by the authors determined that moderate correlation between bis and the two clinical sedation scales. Clinical privileges and other responsibilities of certified registered nurse anesthetists, professional practice documents, and publications and research. The bis index is a processed eeg parameter with extensive validation and demonstrated clinical utility. Pdf role of the bispectral index in sedation monitoring. The bispectral index was first developed in the early 1990s by applying bispectral analysis to eeg recordings. Bis index values are the result of two particular innovations. The use of the bispectral index in the detection of pain in. When the bispectral index bis can give false results scielo. All patients that are receiving neuromuscular blockade.
The resultant eeg is a low voltage 1 mv signal, requiring amplification and signal processing. Validation of the bispectral index monitor for measuring the. Critical care aspect medical systems international b. Listing a study does not mean it has been evaluated by. Bispectral index bis monitoring systems allow anesthesia. It is unique among the quantitative electroencephalogram qeeg parameters because it integrates several independent descriptors of the eeg into a single variable. The bis monitor is the first quantitative eeg index introduced into clinical practice. The use of the bispectral index in the detection of pain. It was obtained from the algorithm based on the analysis of a large number of eegs from volunteers and. Apr 23, 2016 intraoperative use of bispectral index monitoring and time to extubation and patients length of stay after cardio pulmonary bypass surgery, at annajah national university hospital nablus palestine. Bispectral index monitoring an overview sciencedirect. The bispectral index bis is a newly processed electroencephalogram parameter that was specifically developed to measure the hypnotic effects of anesthesia. Bispectral index bis monitoring standard of practice icu. Bis monitors are intended to replace or supplement guedels classification system for determining depth of.
Variation of bispectral index under tiva with propofol in a paediatric population. Depth of anaesthesia monitors bispectral index bis, eentropy. Validation of the bispectral index monitor for measuring. It was obtained from the algorithm based on the analysis of a large number of eegs from volunteers and patients undergoing sedation and general anesthesia. Jun 12, 2009 bispectral index bis on ventilated patients in the prehospital setting ohbis the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The bis is an empirical, statistically derived measurement. A book containing references, alphabetically arranged, to the contents of a series or collection of documents or volumes. Bispectral index bis monitoring level of consciousness with the compact bisx power link philips bispectral index bis measurement uses aspect medical systems xp platform technology. It provides depth of consciousness and sedation monitoring for use in the or, icu, and other clinical settings. Bispectral analysis is a signal processing methodology that.
The bispectral index monitor is connected to a sensor which is placed on the forehead of the patient. Bispectral index is one of several technologies used to monitor depth of anesthesia. During surgery, in addition to the intraoperative standard monitorizationthatincluded electrocardiogram, invasive blood pressure monitoring, pulse oximetry, temperature probe and central venous pressure monitoring, bispectral index monitoring bis was added for cerebral ischemia detection. Highlights from the 2015 guidelines update benjamin s. Time course of the bispectral index bis of volunteer kt.
The bispectral index bis depth of anaesthesia monitor is therefore recommended as an option in these patients. The bispectral index bis, aspect medical systems, natick, ma is a complex parameter, composed of a combination of time domain, frequency domain, and high order spectral subparameters 5. Bispectral index monitoring may be easier to perform and may require less. Background awareness during anesthesia is a serious complication with potential longterm psychological consequences. Bispectral index bis monitoring is one of several technologies which monitor depth of anaesthesia. Technology assessment series are freely available in pdf format at the. Watcha, md departments of anesthesiology and radiology, the childrens hospital of philadelphia, university of pennsylvania. Bispectral index bis monitoring system rx only ec rep aspect medical systems, inc. Bis monitors are intended to replace or supplement guedels classification system for determining depth of anaesthesia. Anesthesia awareness and the bispectral index nejm. Validating the sedationagitation scale with the bispectral.
602 388 394 114 628 1586 414 68 260 656 11 366 1225 1425 1575 824 670 629 1593 21 1041 1428 588 773 418 1218 407 401 910 847