BIS Technology Enabling safety and quality improvements in the operating room

BIS technology backs you up with proven brain monitoring.

Given the complexity of the decisions you face, it makes sense to incorporate the added security of BIS monitoring into your practice. Used in millions of procedures requiringUsing the BIS monitor has made me more of a scientist and a more perceptive clinician. It is, in short, an essential part of modern anesthesia. IrEnE OSBOrn, MD Mt. Sinai Medical Center

InSIghT InTO BraIn rESpOnSES1 B IScanhelpclarifythedistinction betweenbrainandspinalcord responses,enablingyoutomanage anestheticgoalsofhypnosis,

BraIn Consciousness Memory function

anesthesia, BIS technology can provide insight into the direct and patient-specific effects of anesthesia on the brain. hOw BIS wOrkS R awEEGdataareobtainedthrougha sensorplacedonthepatientsforehead Th eBISsystemprocessestheEEG informationandcalculatesanumber between0and100thatprovidesa directmeasureofthepatientslevelBIS InDEx rangE

BIS rangE anD CLInICaL STaTE

analgesia,andimmobility ecauseBISmeasureselectrical B activityinthebrain,itprovidesa directcorrelationwithdepthof consciousness(hypnosis) esponsestosurgicalstimulation R arefrequentlyindicatorsoftheneed foradditionalanalgesia.These responsesareoftenmediatedinthe spinalcord ISenablesyoutoassess B consciousnessandsedation separatelyfromcardiovascularHYPNOSIS

100

awake Responds to normal voice Light / Moderate Sedation

80

May respond to loud commands or mild prodding / shaking

ofconsciousness A BISvalueof100indicatesthepatient isfullyawake A BISvalueof0indicatestheabsence ofbrainactivity

60

general anesthesia Low probability of explicit recall Unresponsive to verbal stimulus

SpInaL COrD analgesia reflex movement

40

Deep hypnotic State

20

Burst Suppression

reactivityBALANCED ANESTHESIA

0

Flat Line EEg

ANALGESIA

IMMOBILITY

This chart reflects a general association between clinical state and BIS values. Ranges are based on results from a multi-center study of the BIS involving the administration of specific anesthetic agents. BIS values and ranges assume that the EEG is free of artifacts that can affect its performance. Titration of anesthetics to BIS range should be dependent upon the individual goals established for each patient. These goals and associated BIS ranges may vary over time and in the context of patient status and treatment plan.

BIS Improves Safety and Efficiency in the OrBIS MOnITOrIng anD FaSTEr wakE upS9 BIS-monitored patients wake up faster, are extubated sooner, and are more oriented on arrival at the post-anesthesia care unit (PACU). BIS MOnITOrIng anD rEDuCED rISk OF awarEnESS In aDuLTSThe Cochrane review on BIS authors conclusion: Anaesthesia guided by BIS within the recommended range (40-60) could improve anaesthetic delivery and postoperative recovery from relatively deep anaesthesia. In addition, BIS-guided anaesthesia has a significant impact on reduction of the incidence of intra-operative recall in surgical patients with a high risk of awareness.13

paTIEnTS OrIEnTED On arrIvaL aT paCuMore patients oriented on arrival at PACU9

50% 40% 30% 20% 10% 0%Standard Practice

87% 43%

Researchdemonstratesthatawareness withrecalloccursin1to2patientsper 1000receivinggeneralanesthesia.2,3,4 warenessisaleadingcauseofpatient A dissatisfactionwithanesthesia.5 ISistheonlyconsciousnessmonitoring B technologyproveninrigorousprospective clinicalstudiestohelpcliniciansreduce theincidenceofawarenesswithrecallin adultsbyapproximately80%. 6,8

0,000to40,000casesofawareness 2 withrecalloccureachyearintheUS. ISmonitoringmayplayarolein B helpinghealthcareorganizationsaddress therecommendationsproposedinthe JCAHOSentinelEventAlert2onpreventingandmanagingtheimpactof anesthesiaawareness. BIS MOnITOrIng anD ShOrTEr paCu STayS BIS-monitored patients have been shown to be eligible for PACU discharge 32% sooner.10

23%

BIS Titrated

paCu DISChargE TIME200 180 160 140 120

195Faster discharge from PACU10

32% 132Standard Practice BIS Tricated

MyLES, ET aL. TrIaL61%11 casesReduction in incidence of awareness with recall in adults (high risk patients p