Really under during surgery? Monitor can tell

[Guest guest]

Really under during surgery? Monitor can tell

NEW YORK (Reuters Health) - Horror stories abound of surgery patients being

aware they're being operated on, but unable to move or say anything. A new

type of monitoring should help prevent that happening.

For every 1000 patients operated on, it's thought that up to 2 become aware

during surgery. This can be reduced, an Australian study suggests, by

monitoring brain patterns during the operation to guide the administration

of general anesthesia.

Monitoring the " bispectral index " (BIS) of brain EEG patterns indicates the

depth of anesthesia and helps the anesthesiologist make adjustments,

according to Dr. S. Myles from the Department of Anesthesia and Pain

Management at the Alfred Hospital in Melbourne, and colleagues.

However, they note in this week's issue of The Lancet medical journal, the

value of BIS " as a monitor for awareness has not previously been assessed in

a randomized trial. "

To investigate, the team randomly assigned 2463 surgery patients to

BIS-guided anesthesia or standard care. The patients were questioned about

their awareness of the procedure a few hours, one day, and one month after

surgery by a researcher who did not know which group they were in.

There were two reports of awareness in the BIS group compared with 11 in the

standard care group, meaning that BIS-guided anesthesia reduced the risk of

awareness by 82 percent.

" BIS monitoring had little effect on the time needed to recover from general

anesthesia, as measured by eye opening, and no measurable effect on the

risks of postoperative complications, " the team notes.

They conclude, based on their results, that " greater use of BIS monitoring

is warranted. "

This study is a " great advance, " two clinicians from Sweden write in an

editorial.

" In addition to immediate suffering due to pain and anxiety, other

psychological symptoms, or even post-traumatic stress disorder, might follow

after awareness, " Drs. Claes Lennmarken from University Hospital in

Linkoping and Rolf Sandin from the Karolinska Institute in Stockholm

comment.

" Clearly the data show that cerebral monitoring has the potential to further

reduce the rate of awareness compared with traditional measures, " they

write.

SOURCE: Lancet, May 29, 2004.

[Guest guest]

We have BIS monitors where I work. They indicate sedation, but NOT pain

control. Meaning, in an ICU, you could be too sedated to speak or move, but

still

be in pain. Have to be careful how you use these!

Cary