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Practice patterns in the intraoperative use of bispectral index monitoring

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Abstract

Assessing the depth of anesthesia and reducing intraoperative awareness has become a focus of much technology development and research in the field of anesthesia. Bispectral index (BIS) is the most widely utilized technology that uses electroencephalogram to provide a measurement of anesthetic depth. There are no definitive guidelines on when BIS should be used. Our aim was to assess actual patterns of intraoperative use of BIS by anesthesia professionals. We retrospectively collected intraoperative data on 55,210 surgical cases at a tertiary care hospital. Variables collected included: age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, anesthesia provider type and level of training, use of inhalational anesthetics versus total intravenous anesthesia (TIVA), utilization of nitrous oxide, utilization of non-depolarizing neuromuscular blockade, emergency status of surgery, airway type, case duration, and surgical subspecialty. A univariate logistic regression model was fitted. Subsequently, a multivariate logistic regression model was applied. Covariates utilized for the model included age, anesthesia provider level, and length of case. Factors associated with BIS use included increased age, greater ASA physical status, extremes of BMI, use of TIVA, use of a long-acting paralytic agent, use of an endotracheal tube (ETT), emergency surgery, increasing length of case, and certain surgical services. BIS use was associated with previously documented risk factors for intraoperative awareness. These factors are also indicators of case complexity, which may be a major factor among providers deciding when to apply BIS monitoring in the operating room.

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Notes

  1. CA is clinical anesthesia. After a base year in either surgery or medicine, anesthesia residents are categorized in years from 1 to 3. CA-1’s are considered junior residents. CA-2 and CA-3 years are considered senior residents.

  2. Defined in this institution as cases going to the OR within 30 min of booking.

References

  1. Shepherd J, Jones J, Frampton G, Bryant J, Baxter L, Cooper K. Clinical effectiveness and cost-effectiveness of depth of anaesthesia monitoring (E-Entropy, Bispectral Index and Narcotrend): a systematic review and economic evaluation. Health Technol Assess. 2013;17:1–264.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Leslie K, Myles PS, Forbes A, Chan MT. The effect of bispectral index monitoring on long-term survival in the B-aware trial. Anesth Analg. 2010;110:816–22.

    Article  PubMed  Google Scholar 

  3. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84:6–10.

    Article  CAS  PubMed  Google Scholar 

  4. Sebel PS, Bowdle TA, Ghoneim MM, Rampil IJ, Padilla RE, Gan TJ, Domino KB. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg. 2004;99:833–9 (table of contents).

    Article  PubMed  Google Scholar 

  5. Kelley SD. Intraoperative awareness. In: Vacanti C, Segal S, Sikka P, Urman R, editors. Essential clinical anesthesia. Cambridge: Cambridge University Press; 2011. p. 209–12.

    Chapter  Google Scholar 

  6. Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg. 2009;108:527–35.

    Article  PubMed  Google Scholar 

  7. Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet. 2004;363:1757–63.

    Article  CAS  PubMed  Google Scholar 

  8. Mashour GA, Shanks A, Tremper KK, Kheterpal S, Turner CR, Ramachandran SK, Picton P, Schueller C, Morris M, Vandervest JC, Lin N, Avidan MS. Prevention of intraoperative awareness with explicit recall in an unselected surgical population: a randomized comparative effectiveness trial. Anesthesiology. 2012;117:717–25.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, Saager L, Turner MS, Rao S, Bottros M, Hantler C, Jacobsohn E, Evers AS. Anesthesia awareness and the bispectral index. N Engl J Med. 2008;358:1097–108.

    Article  CAS  PubMed  Google Scholar 

  10. Punjasawadwong Y, Phongchiewboon A, Bunchungmongkol N. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2014;6:Cd003843.

    Google Scholar 

  11. Short TG, Leslie K, Campbell D, Chan MT, Corcoran T, O’Loughlin E, Frampton C, Myles P. A pilot study for a prospective, randomized, double-blind trial of the influence of anesthetic depth on long-term outcome. Anesth Analg. 2014;118:981–6.

    Article  CAS  PubMed  Google Scholar 

  12. Park SW, Lee H, Ahn H. Bispectral index versus standard monitoring in sedation for endoscopic procedures: a systematic review and meta-analysis. Dig Dis Sci. 2016;61:814–24.

    Article  PubMed  Google Scholar 

  13. Shao X, Fang W, Xu Y. 755: bispectra index for monitoring the sedation levels in patients with mechanical ventialtion in the ICU. Crit Care Med. 2015;43:190.

    Article  Google Scholar 

  14. Abenstein JP. Is BIS monitoring cost-effective? Conf Proc IEEE Eng Med Biol Soc. 2009;2009:7041–4.

    CAS  PubMed  Google Scholar 

  15. Kanonidou Z, Karystianou G. Anesthesia for the elderly. Hippokratia. 2007;11:175–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Wong J, Song D, Blanshard H, Grady D, Chung F. Titration of isoflurane using BIS index improves early recovery of elderly patients undergoing orthopedic surgeries. Can J Anaesth. 2002;49:13–8.

    Article  PubMed  Google Scholar 

  17. Charlson ME, Karnik J, Wong M, McCulloch CE, Hollenberg JP. Does experience matter? A comparison of the practice of attendings and residents. J Gen Intern Med. 2005;20:497–503.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Pitts SR, Morgan SR, Schrager JD, Berger TJ. Emergency department resource use by supervised residents vs attending physicians alone. JAMA. 2014;312:2394–400.

    Article  CAS  PubMed  Google Scholar 

  19. Ghoneim MM. Awareness during anesthesia. Anesthesiology. 2000;92:597–602.

    Article  CAS  PubMed  Google Scholar 

  20. ASA. 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.

    Article  Google Scholar 

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Funding

Internal Departmental Funding | Recipient: Richard D. Urman, MD, MBA.

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Correspondence to Richard D. Urman.

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Gelfand, M.E., Gabriel, R.A., Gimlich, R. et al. Practice patterns in the intraoperative use of bispectral index monitoring. J Clin Monit Comput 31, 281–289 (2017). https://doi.org/10.1007/s10877-016-9845-5

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  • DOI: https://doi.org/10.1007/s10877-016-9845-5

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