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Concept
Bispectral index
Summary
Bispectral index (BIS) is one of several technologies used to monitor depth of anesthesia. BIS monitors are used to supplement Guedel's classification system for determining depth of anesthesia. Titrating anesthetic agents to a specific bispectral index during general anesthesia in adults (and children over 1 year old) allows the anesthetist to adjust the amount of anesthetic agent to the needs of the patient, possibly resulting in a more rapid emergence from anesthesia. Use of the BIS monitor could reduce the incidence of intraoperative awareness during anaesthesia. The exact details of the algorithm used to create the BIS index have not been disclosed by the company that developed it.
BIS cannot be used as the sole monitor of anaesthesia, as it is affected by several other factors, including the anaesthetic drugs used (BIS is relatively insensitive to agents such as ketamine and nitrous oxide), and muscle movement or artefact from surgical equipment. BIS is used as an adjunct to monitoring under anaesthesia - its use has been shown to reduce overall dose of anaesthetic agent used and therefore may improve recovery time from anaesthesia.
The BIS was introduced by Aspect Medical Systems, Inc. in 1994 as a novel measure of the level of consciousness by algorithmic analysis of a patient's electroencephalogram during general anesthesia. This is used in conjunction with other physiologic monitoring such as electromyography to estimate the depth of anesthesia in order to minimize the possibility of intraoperative awareness. The US Food and Drug Administration (FDA) cleared BIS monitoring in 1996 for assessing the hypnotic effects of general anesthetics and sedatives. The FDA further stated in 2003 that "...A reduction in awareness provides a public health benefit, in that BIS technology can now provide anesthestists with a way to reduce this often debilitating, yet preventable medical error". Aspect Medical was acquired by Covidien in 2009.
The bispectral index is a statistically based, empirically derived complex parameter.
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General anaesthesia
General anaesthesia (UK) or general anesthesia (US) is a method of medically inducing loss of consciousness that renders a patient unarousable even with painful stimuli. This effect is achieved by administering either intravenous or inhalational general anaesthetic medications, which often act in combination with an analgesic and neuromuscular blocking agent. Spontaneous ventilation is often inadequate during the procedure and intervention is often necessary to protect the airway.