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BIS Monitoring

ANP1 Exam 3

BIS "bispectral index" - noninvasive neurophysiologic monitoring device that continually analyzes pts EEG to assess the level of consciousness during anesthesia
EEG 1. monitors cerebral fx & provides early evidence of cerebral ischemia 2. records stages of wakefulness and consciousness resulting from neurotransmitter activity
depth of anesthesia likelihood of forming memory
bispectral analysis bispectral index of an EEG = wt'd sum of EEG subparameters of time domain, frequency domain, higher order spectral info
how the BIS works EEG that employs computerized algorithms to incorporate established EEG patterns into usable info
risk for awareness - high to low 1. OB (GA is emergent ie 30 sec) 2. major trauma 3. CP bypass 4. physiologically most fragile (elderly) 5. multiple co-morbidities 6. ETOH/drug abusers
factors contributing to awareness 1. polypharmaceutical approach to anesthetic 2. TIVA (gas gives better amnesia) 3. premature lightening for rapid turnover
steps to ↓ risk of awareness 1. premedicate w/ amnestic drugs 2. give more than "sleep dose" of induction agents if followed immediately by intubation 3. avoid NMBDs unless absolutely necessary 4. periodic maintenance of machine/vaporizers 5. CHECK machine/vent prior to use
BIS = ZERO EEG silence
BIS = 100 expected value in fully awake adult
BIS = 40-60 generally accepted level for GA (manufacturer claims never been recall case when documented BIS < 60)
BIS = 75-80 pt can start to move
BIS changes with noxious stimuli lack of analgesia (can be used to monitor lack of analgesia - lower drug utilization w/o ↑ somatic s/s of light anesthesia ie movement, hemodynamics)
when to place BIS ideally before induction to establish baseline
BIS SQI Signal Quality Index - quality of EEG 0-100 ~want ↑↑ # ~not reliable if <80
BIS EMG Electromyograph - 30-55 - absolute power in 70-110 Hz frequency band (this freq. band contains power from muscle activity as well as high freq artifacts ~ want ↓↓ # ~ reasonably accurate BIS if < 25
BIS SR suppression ratio - indicates % of suppressed (flatline) EEG detected over last 63 sec
BIS smoothing rate time period over which artifact-free data is analyzed to calculate the BIS #. affects trend & #. Factory default = 15 sec. 'smoother' trend with 30 sec.
Created by: girlnamedsharon