"Because measuring the brain's response to anesthetics challenges the deeply held belief system that heart rate and blood pressure are reliable guides to depth of anesthesia," opines Dr. Friedberg (N.B. Heart rate and blood pressure are unreliable guides.)
In the well-known fairy tale, Goldilocks finds Poppa bear's porridge too hot, Mama bear's porridge too cold, but Baby bear's porridge just right. 'Goldilocks' anesthesia alludes to minimally invasive anesthesia(MIA)(R) wherein patients are neither over-anesthetized nor under-anesthetized but 'just right!'
BIS has a scale of 0-100. Awake is BIS 98-100. Recall rarely occurs at BIS below 75. MIA falls between BIS 60-75. General anesthesia (the sleep portion) falls between BIS 45-60. Overdosed is BIS less than 45.
Unfortunately for the patient, anesthesia at BIS below 45 is remarkably commonplace.
The consequences of overdosing may be just as sinister as under-dosing.
It is not uncommon for relatives of elderly patients to observe that, in layman's terms, they are 'not quite the same' after their anesthesia as they were before surgery. This phenomenon is formally known as postoperative cognitive dysfunction (POCD).
"Many believe POCD may also be a function of anesthetic overdose," states Friedberg.
"Given its history with pulse oximetry, the public should not rely on the ASA to insist that BIS monitoring be a standard of care," asserts Friedberg, a long time ASA non-member.
"The greatest good that could come from 'Awake' the movie would be a groundswell of public opinion demanding routine BIS monitoring for general anesthesia," states Friedberg who routinely monitors his patients with BIS and believes it to be the 'standard of care.'
Disclaimer: Dr. Friedberg is not employed by Aspect Medical Systems,
makers of the BIS monitor. He is not a stockholder or a paid consultant.
The opinions expressed herein are his profession
|SOURCE Cosmetic Surgery Anesthesia|
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