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2007, Number 2

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Rev Mex Anest 2007; 30 (2)

Intra-operative awareness and bispectral index; its impact in the practice of anesthesiology

Carrillo-Esper R, Carrillo-Córdova LD, Carrillo-Córdova JR

Language: Spanish
References: 43
Page: 97-104
PDF size: 82.67 Kb.


ABSTRACT

Intra-operative awareness (IA) varies widely from full consciousness to poor recollection of events. Remembering intra-operative events is one of the main fears of patients undergoing general anesthesia. IA occur in 1/1,000 non-cardiac surgery patients and in 3/1,000 cardiac surgery patients. This makes IA one of the most serious complications of anesthesia; the large quantity of published papers and medico-legal cases point out its relevance. Patients with IA claim they feel paralysis, hear conversations and feel the surgical manipulations; also, they feel helplessness, fear and pain. While patients usually recognize the event as real, few report their experience to the anesthetist. Post-traumatic stress disorder may develop as a devastating sequel of awareness, thus having a negative impact in patients’ quality of life. The clinical signs of somatic or autonomic responsiveness have always been the mainstay of anesthetic depth monitoring, but they have low sensitivity and specificity to identify IA. Other techniques to this end (the isolated forearm technique, frontalis electromyography and lower esophageal sphincter contractility) have proven not being useful in clinical practice. Many attempts to produce a simplified interpretation of the electroencephalogram (EEG) that predicts anesthetic depth have been made, but, in most cases, the results were unsatisfactory. Recently, sophisticated pattern recognition systems to assess multiple features of the EEG have been developed. The bispectral index monitor (BIS) analyses the level of consciousness during anesthesia and displays a single number derived from bispectral analysis of the EEG. The BIS ranges from zero to 100; the values below 60 are associated with unconsciousness. BIS has shown to be a reliable indicator of the level of consciousness; that would contribute to decrease significantly IA and to optimize the dose of drugs. Also would reduce the length of stay at the post-anesthetic care unit and the costs of care.


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