UK’s National Institute for Health and Clinical Excellence (NICE) has recommends the use of electroencephalography (EEG)-based monitors, specifically the Bispectral Index (BIS, Covidien) monitor, as an option for measuring depth of anaesthesia.
The recommendation specifies that the BIS monitor should be used with all patients receiving total intravenous anaesthesia and during any type of general anaesthesia with patients considered at high risk of adverse outcomes. This includes patients at high risk of unintended awareness and patients at high risk of excessively deep anaesthesia. The BIS Brain Monitoring System helps clinicians assess patient consciousness levels through electrical activity in the brain.
The NICE guidance specifically recommends the BIS system as an option in the care of patients at high risk for unintended awareness (consciousness) or excessively deep anaesthesia levels during surgery. Both can lead to serious short- and long-term health risks, including post-traumatic stress disorder, heart attack, and stroke and in older patients, cognitive dysfunction or “brain fog.”
Patients at high risk for unintended awareness include older patients as well as those with morbid obesity, poor cardiovascular function, presence of two or more chronic diseases, high opiate or alcohol use, intravenous anaesthesia techniques and certain types of surgical procedures.
The recommendation for BIS monitoring as an option in patients receiving total intravenous anaesthesia was made because it is cost effective and because it is not possible to measure anaesthetic concentration in these patients.
“The NICE assessment and recommendations provide clear guidance to anaesthesia professionals regarding the use of depth of anaesthesia monitoring that will greatly improve patient care and safety for individuals at higher risk for adverse reactions to general anaesthesia,” said Scott Kelley, chief medical officer, Respiratory and Monitoring Solutions, Covidien. “With BIS brain monitoring technology, anaesthetists, in combination with their other standard practices, can accurately determine consciousness and tailor anaesthesia dosing to ensure optimal patient experience and minimise risks.”
The NICE Diagnostics Guidance is based on extensive clinical evidence and an assessment report prepared by the University of Southampton’s Southampton Health Technology Assessment Centre and input from a number of professional organisations and device manufacturers. Other brain monitoring technologies assessed as part of the clinical research include the GE Healthcare E-Entropy and Schiller Narcotrend-Compact M.