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Method to Detect When Patients Wake During Surgery Fails to Impress
Date:8/18/2011

ich ETAC can't monitor -- or low-risk patients, who were not included in this study, said Dr. Devi E. Nampiaparampil, an assistant professor of anesthesiology and rehabilitation at NYU School of Medicine in New York City.

Neither Schlesinger, McAllister nor Nampiaparampil were involved with the study, which appears in the Aug. 17 issue of the New England Journal of Medicine.

Patients at high risk for anesthesia awareness can include those who have undergone trauma in an accident and have unstable vital signs, or someone who can't tolerate high levels of anesthesia, Schlesinger explained. This group of patients also includes those who regularly consume large quantities of alcohol and those taking sedatives or certain kinds of painkillers.

"[Anesthesia awareness] continues to affect substantial a number of patients and to be a cause of real distress and long-term consequences for those who experience it," said study author Dr. Michael Avidan.

Avidan marveled at the paucity of nervous system monitoring for anesthesia patients, compared to those that monitor the cardio-respiratory system.

"That's surprising because the nervous system is really the target of anesthesia," said Avidan, who is division chief of cardiothoracic anesthesia and cardiothoracic intensive care at Washington University School of Medicine in St. Louis.

This is the third trial of BIS in recent years, starting with a 2004 study that found that using BIS monitors could reduce awareness incidence by 82 percent. A 2008 trial by the same group of researchers found that BIS didn't perform as well as ETAC, leading the team to try a still larger trial.

For this study, the researchers randomized 6,000 patients at high risk for anesthesia awareness to either BIS-guided anesthesia or ETAC-guided anesthesia.

Seven patients (0.24 percent) in the BIS group recalled being aware during the procedure, compared to 2 (0.07 percent) in the ETAC group.

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