title: Bispectral index monitoring: appreciated but does not affect drug dosing and hypnotic levels.
abstract: BACKGROUND
  Bispectral index (BIS) has been associated with benefits from less-deep anesthesia as well as preventing awareness, albeit not at the same time. We investigated how increasing experience from BIS in clinical practice affect the hypnotic level, drug consumption, as well as subjective opinions on this monitoring.
  
  
  METHODS
  Eight certified registered nurse anesthetists (CRNAs) with previous experience from 88 (46-121) BIS monitored cases anesthetized 80 cases with concealed BIS, followed by 80 cases with available BIS. Additional education and training was followed by yet another 160 patients randomized to open or blindly recorded BIS. BIS levels, anesthetic gas consumption, fentanyl use, and subjective opinions on utility and reliability were investigated.
  
  
  RESULTS
  After gaining initial experience from BIS monitoring, the fraction of time with BIS levels of 40-60 did not deteriorate in cases with concealed monitoring and no further improvement was found in subsequent cases with available data from the BIS monitoring, not even after additional training and encouragement to adhere to the 40-60 interval. Compared with the first experience from BIS monitoring the subjective opinions on utility had increased from 33 to 78 mm (100 mm visual analog scales) (P<0.0001).
  
  
  CONCLUSIONS
  Although BIS became considerably appreciated, growing experience and repeated education had no impact on drug dosing and BIS levels.
authors.affiliation: Department for Physiology and Pharmacology; Section for Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden. majlisl@ltkalmar.se
authors.forename: M-L
authors.initials: ML
authors.lastname: Lindholm
authors.forename: L
authors.initials: L
authors.lastname: Brudin
authors.forename: R H
authors.initials: RH
authors.lastname: Sandin
mesh_terms: D000328:Adult; D000769:Anesthesia, Inhalation / Q000706:statistics & numerical data*; D000771:Anesthesia, Intravenous / Q000706:statistics & numerical data; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D001364:Awareness; D003657:Decision Making; D004569:Electroencephalography; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006184:Habits; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods* / Q000706:statistics & numerical data; D009042:Motivation; D009609:Nitrous Oxide / Q000008:administration & dosage*; D009719:Nurse Anesthetists / Q000193:education / Q000523:psychology*; D015742:Propofol / Q000008:administration & dosage; D000077149:Sevoflurane; D016037:Single-Blind Method; D013874:Thiopental / Q000008:administration & dosage
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D013874:Thiopental; D009609:Nitrous Oxide; D005283:Fentanyl; D015742:Propofol