Bispectral index (BIS)

[shr7]

I know there are several surgeons and surgical PA's on this board, I am wondering if there are any ICU docs as well? Down at the local hospital we use the BIS frequently in cases where general anesthesia is used. I have no personal experience with the OR, but I was wondering how widespread the practice of using this monitoring parameter is. It seems the BIS is only indicated for monitoring the hypnotic effects of general anesthetics and sedatives. Recently, though, it seems it was approved as a parameter to control awareness incidence. With this new indication, the BIS seems to have proliferated in differing environments.

My question is to any ICU docs out there. Do you use the BIS to control ICU sedation? As a stupid young pharmacy student talking in front of a bunch of stupid young med students, I would hate to sound like a total jackass. My literature search revealed mixed results, with some passionate articles written both for, and against, its use. It seems the advantage is to use it to monitor for deep sedation, where monitoring subjectively becomes impossible, as well as monitoring for sedation in ICU patients undergoing NMB. It would seem to be difficult to use in lightly sedated patients because of muscle based electrical activity as well as no differentiation between alert/awake/cooperative and pulling-out-lines/agitated. Would you characterize this position as accurate and/or consistent with your hospital policy?

I am also interested to hear what the surgeons/PA's say who have used or seen this device. As well, I know there are a growing number in use in ambulances and other mobile ICU's. Have any of you paramedics or EMT's seen or used these devices, and to what end?

Thank you very much. I am much more comfortable with drugs than devices. God help me if they ask me how exactly an EEG is translated into a number...

SR