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 requiring
Using 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 directmeasureofthepatientslevel
BIS 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 separatelyfromcardiovascular
HYPNOSIS

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

reactivity
BALANCED ANESTHESIA

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 Or

BIS 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 aDuLTS
The 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 paCu

More 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 TIME

200 180 160 140 120

195
Faster discharge from PACU10

32% 132
Standard Practice BIS Tricated

MyLES, ET aL. TrIaL6

1%
11 cases
Reduction in incidence of awareness with recall in adults (high risk patients p<.05)

avIDanS, ET aL. TrIaL7

Observed incidence of awareness with recall

EkMan, ET aL. TrIaL8

BIS MOnITOrIng anD Drug SavIngS9-12

0.2%
14 cases
Reduction in incidence of awareness with recall in adults (general patient population p<.05)

% rEDuCTIOn In Drug uTILIzaTIOn wITh BIS

1300 1200
Propofol mg.

1.0% .75% .50%

1%

Multiple prospective randomized studies have measured the influence of BIS-guided anesthesia care compared to standard practice. Studies have shown reductions in the use of hypnotic anesthetics when anesthetics are titrated to the BIS index.

1253
mg

Reduction in drug utilization with BIS9

0.5%

0.1%

1100 1000 900 800

Standard Practice

82%
2 cases

.21
.25% 0%
2 cases BIS-guided protocol n = 967 Expected Incidence of Awareness in High Risk Patients

.21
2 cases ETAG protocol n = 974

77%
2 cases

23% 964
mg
BIS

0%

Standard Practice (No BIS) n = 1,238

BIS-guided protocol n = 1,225

0%

Historical Control n = 7,826

BIS-guided protocol n = 4,945

BIS is an invaluable teaching toolit equips my students with the information they need to determine when they can safely titrate back their anesthetic. The added confidence that BIS provides has a significant impact on the quality and efficiency of the anesthesia they administer.
JoHn odonnELL, CRnA University of Pittsburgh Medical Center

IMprOvIng quaLITy anD SaFETy FOr a varIETy OF paTIEnTS6,9,11,12,14

BIS information enables us to give each patient the precise amount of anesthetic they require, thereby increasing efficiency and reducing the risk of awareness and postoperative side effects of drugs, such as nausea and vomiting. With BIS, patients wake faster, feel more alert, and go home earlier.
JAMES MAyFIELd, Md Medical director of Perioperative Services Medical College of Georgia Health System

wIDELy STuDIED, wIDELy aCCEpTED, wIDELy InTEgraTED BIStechnologyis   upportedbythousandsofpublished S articlesandabstracts   vailableextensivelythroughoutEurope, A Asia,Australia,andtheAmericas   icensedforintegrationintothe L patientmonitoringsystemsofleading manufacturers

BIS IS rEaDy whEn yOu arE YoucannowaccessthefullbenefitsofBIStechnologywithBISx,adevicethatallows youtointerfacewithanyBISReadypatientmonitoringsystem.SimplyplugBISxinto aBISReadysystemandBISinformationisdisplayedalongwithothervitalsigns.* BISxintegrateswithsystemsinvirtuallyeveryhealthcareenvironment,fromhigh-end systemsinORsandintensivecareunits(ICU)topreconfiguredsystemsinambulatory surgerycentersorproceduralsedationlocations.BISxalsoprovidestheflexibilityto travelwiththepatientthroughoutthehospital(requirescompatiblebrand/connectors onpatientmonitoringsystems).
*Available in select monitors.

BISoffersyouaddedsecurityinproviding specializedcareandcomfortforyour patients,includingthosewhomaybe moresensitivetothehemodynamic effectsofanesthesia. BISprovidesvaluableinformationabout thestatusofyourpatientstohelpaddress theiruniqueanestheticrequirements. Thismaybeparticularlyvaluablefor:   atientswithcomplexconditionswhose P statusmaysuddenlyorfrequentlychange   atientswithcardiovascularconditions P   besepatients O   raumapatientsorothersrequiring T reducedlevelsofanesthesia

ThE BIS FaMILy OF SEnSOrS The family of BIS sensors includes   eQuatroSensorforadultpatientsundergoinggeneralanesthesiaorsedation Th   eExtendSensorforadultpatientsmonitoredforalongperiodoftime,suchas Th thoseintheICU   ePediatricSensorforsmallerpatients Th   eBilateralSensortoenabledetectionofhemisphericdifferencesinthebrainwhich Th mayproveusefulforadvancedmonitoringapplications*
*Bilateral hardware required. Hardware includes BISx4 and PIC-4 cable.

BIS quaTrO

BIS pEDIaTrIC

BIS ExTEnD

BIS BILaTEraL

BIS solutions to meet your needs.

Covidien offers the proven brain function monitoring of BIS in a variety of solutions to provide you with the flexibility to monitor across the continuum of care.

BIS vISTa Monitoring System

BIS Fully Integrated Seamless solution Datascope Dixtal

BIS vISTa Bilateral Monitoring System

Drger Medical general Electric Mennen Medical Mindray

BIS vIEw Monitoring System

nihon kohden philips SpaceLabs healthcare

references: 1. dershwitz M. Should we measure depth of anesthesia? Semin Anesth Perioper Med Pain. 2001;20:246-256. 2. Joint Commission on Accreditation of Healthcare organizations: Preventing, and managing the impact of, anesthesia awareness. Sentinel Event Alert. oct 6, 2004;(32):1-3. 3. Practice Advisory for Intraoperative Awareness and Brain Function Monitoring: A Report by the American Society of Anesthesiologists Task Force on Intraoperative Awareness. Anesthesiology. 2006;104:847-64. 4. Sebel PS, Bowdle TA, Ghoneim MM, et al. The incidence of awareness during anesthesia: A Multicenter United States Study. Anesth Analg. 2004;99:833-839. 5. Myles PS, Williams dL, Hendrata M, et al. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6-10. 6. Myles PS, Leslie K, Mcneil J, et al. Bispectral Index monitoring to prevent awareness during anaesthesia: the B-Aware randomized controlled trial. Lancet. 2004;363:1757-1763. 7. Avidan M, et al. The new England Journal of Medicine. 2008; 358:1097-108. 8. Ekman A, Lindholm ML, Lennmarken C, et al. Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand. 2004;48:20-26. 9. Gan TJ, Glass PS, Windsor A, et al. Bispectral Index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology. 1997;87:808-815. 10. White PF, Ma H, Tang J, et al. does the use of electroencephalographic Bispectral Index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology. 2004;100:811-817. 11. Wong J, Song d, Blanshard H, et al. Titration of isoflurane using BIS Index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anaesth. 2002;49:13-18. 12. Luginbuhl M, Wuthrich S, Petersen-Felix S, et al. different benefit of Bispectral Index (BIS) in desflurane and propofol anesthesia. Acta Anaesthesiol Scand. 2003;47:165-173 13. Punjasawadwong y, Boonjeungmonkol n, and Phongchiewboon A. Bispectral Index for Improving Anaesthetic delivery and Postoperative Recovery. Cochrane database of Systematic Reviews, 2007; 17(4): Cd003843. 14. Burrow B, McKenzie B, Case C. do anaesthetized patients recover better after Bispectral Index monitoring? Anaesth Intensive Care. 2001;29:239-245.

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