Review of Bispectral Index Monitoring in the Emergency Department and Pediatric Intensive Care Unit

Abstract

1. Describe the purpose and scope of an electronic medical record. 2. Point out the unique demands that the emergency department places upon an EMR. 3. List the advantages and disadvantages of computerized charting.

Glutamatergic Function in the Resting Awake Human Brain is Supported by Uniformly High Oxidative Energy

“…The EEG data were presented as bispectral index (BIS) values, ranging from 0 to 100, representing EEG silence (i.e., isoelectricity) to awake condition, respectively. 26 Bispectral index is based on the weighted sum of several EEG parameters, spanning both time and frequency domains. The BIS measure is intended for monitoring the depth of anesthesia during surgeries where expert interpretation of the raw EEG data in terms of the different frequency bands, which change with overt behavioral variations, is not easily available.…”

“…The BIS measure is intended for monitoring the depth of anesthesia during surgeries where expert interpretation of the raw EEG data in terms of the different frequency bands, which change with overt behavioral variations, is not easily available. 26,27 While EEG is not as quantitative as microelectrode recordings, it has the advantage of noninvasively measuring small voltage fluctuations in vivo resulting from current flows within pyramidal neurons spanning cortical gray matter. 28 As shown in Figure 3A, there is a close to linear dependence of BIS (measured by EEG) with CMR glc (measured by PET).…”

“…However, a limitation of this analysis is that it depends on the quantitative accuracy with which BIS reflects various behavioral states. 27,29 While studies have shown that BIS values correlate well with other clinical sedation scores, 26,27 more studies are needed to assess the trends of BIS values across different sedation levels with different anesthetics. Clearly, the weakest data points in Figure 3A are the vegetative states because of possible tissue damage in cortical regions, which if included or removed do not significantly vary the linear regression tests (i.e., with or without the vegetative state data points, the slope is unchanged while the intercept changes from 0.06 to 0.04 mmol/g per minute).…”

Correlation between the Sedation-Agitation Scale and the Bispectral Index in ventilated patients in the intensive care unit

“…13,14 Similarly, studies on the utility of BIS monitoring in sedated pediatric patients and patients in the emergency department have led researchers to conclude that either BIS was not helpful or that more study is needed. [15][16][17][18] Numerous studies have been conducted in the past decade to determine the role of BIS monitoring of sedation in adult patients in the intensive care unit (ICU). Most early studies either concluded that BIS was a positive addition to ICU sedation monitoring [19][20][21] or that more studies were needed.…”

A review of the utility of EEG depth of anaesthesia monitors in the paediatric intensive care environment

“…A commentary by Playfor (2005) and an editorial by Tobias (2005) advise that more evidence is required before BIS can be supported in PIC. Another non-systematic review, concluded by Dominguez and Helfaer (2006), examined BIS utility in paediatric emergency and intensive care departments. This review reported that due to the range of BIS scores, especially at lighter levels of sedation, BIS utility is limited without further investigation.…”