title: An alternative position for the BIS-Vista montage in frontal approach neurosurgical cases.
abstract: BACKGROUND
  Appropriate placement of the bispectral index (BIS)-vista montage for frontal approach neurosurgical procedures is a neuromonitoring challenge. The standard bifrontal application interferes with the operative field; yet to date, no other placements have demonstrated good agreement. The purpose of our study was to compare the standard BIS montage with an alternate BIS montage across the nasal dorsum for neuromonitoring.
  
  
  METHODS
  The authors performed a prospective study, enrolling patients and performing neuromonitoring using both the standard and the alternative montage on each patient. Data from the 2 placements were compared and analyzed using a Bland-Altman analysis, a Scatter plot analysis, and a matched-pair analysis.
  
  
  RESULTS
  Overall, 2567 minutes of data from each montage was collected on 28 subjects. Comparing the overall difference in score, the alternate BIS montage score was, on average, 2.0 (6.2) greater than the standard BIS montage score (P<0.0001). The Bland-Altman analysis revealed a difference in score of -2.0 (95% confidence interval, -14.1, 10.1), with 108/2567 (4.2%) of the values lying outside of the limit of agreement. The scatter plot analysis overall produced a trend line with the equation y=0.94x+0.82, with an R coefficient of 0.82.
  
  
  CONCLUSIONS
  We determined that the nasal montage produces values that have slightly more variability compared with that ideally desired, but the variability is not clinically significant. In cases where the standard BIS-vista montage would interfere with the operative field, an alternative positioning of the BIS montage across the nasal bridge and under the eye can be used.
authors: Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA. priscilla.nelson@uphs.upenn.edu
authors: Priscilla
authors: P
authors: Nelson
authors: Jonas A
authors: JA
authors: Nelson
authors: Alexander J
authors: AJ
authors: Chen
authors: W Andrew
authors: WA
authors: Kofke
mesh_terms: D000758:Anesthesia; D056805:Consciousness Monitors; D003627:Data Interpretation, Statistical; D004566:Electrodes; D004569:Electroencephalography; D004576:Electromyography; D005625:Frontal Lobe / Q000601:surgery*; D006801:Humans; D016343:Monitoring, Intraoperative; D009296:Nasal Cavity; D019635:Neurosurgical Procedures / Q000379:methods*; D011446:Prospective Studies