NEW TECHNOLOGY MONITORS ANESTHESIA

New monitoring technology that allows anesthesia providers to administer just the right about of medicine is now in use locally at Physicians Alliance Surgery Center.

The ambulatory surgery center at 3241 Percy has a BIS monitor in each of its two operating rooms.

"The biggest advantage of BIS is that we can tailor anesthesia to the individual so patients can rest assured they are going to be asleep throughout the operation," said Andy Schulman, a certified registered nurse anesthetist at Physicians Alliance. And this can be done without overmedicating the patient, he added.

The BIS (Bispectral Index) device, which Schulman described as cutting edge technology, is the first anesthesia monitor developed that analyzes brain function. Approved the by FDA in 1996, the device allows the anesthesia provider to monitor a patient's level of consciousness and make sure the patient will remain unconscious throughout the operation with a much higher level of certainty than ever before, Schulman said.

He said various studies show that of the estimated 20 million people who go under general anesthesia per year, 0.2 percent to 4 percent (that's 40,000 to 800,000 patients) become aware during the procedure.

"This can cause problems afterward like anxiety attacks and post traumatic stress syndrome, even if the patient doesn't remember becoming aware," Schulman said.

He noted that 4 percent isn't a high percentage, "except if it's you."

To prevent this, there has been a tendency to use more medication, Schulman said. But anesthesia medications can have side effects like prolonged sleepiness and nausea and the more that is used, the more likely are side effects, he said.

Drug companies have guidelines to go by on how much medication to use, but each individual reacts to these medications differently.

With BIS, the anesthesia provider can judge how the individual is reacting to the medication and keep the patient at just the right level. Without BIS, anesthesia providers can rely on heart rate, blood pressure and movement monitoring, but these are not as accurate as BIS. Schulman said by monitoring all those vital signs plus having BIS, he can do a more complete job for patients.

To use BIS, an adhesive strip with three EEG pads for measuring brain waves is placed on the patient's forehead. The strip is then connected to the BIS machine with a cord. The EEG readings are analyzed by the machine and consciousness level is given in a single number, Schulman said.

The range is 0, which is no brain function, to 100, which is fully awake. Schulman said most patients are kept in the 40 to 60 range, which is a level where there will be no recall.

"As the procedure goes on, we can adjust the medication to keep the patient where we want him," Schulman said.

He said the surgery center isn't charging extra to use the BIS monitor and it could eventually reduce costs since less anesthesia is used.

Because the amount of medication can be adjusted so accurately, Schulman said patients wake up faster with fewer side effects.

"The recovery room nurses have commented they are amazed at how much faster patients are waking up," he said.

He said most of his patients are ready to walk out the door in less than an hour. Before BIS, they might be in the recovery room for one to 1 1/2 hours.

"BIS allows me to administer anesthesia at exactly the level needed so patients wake up in optimum time, feeling the best they can," Schulman said.