The Use of the Bispectral Index in the Detection of Pain in Mechanically Ventilated Adults in the Intensive Care Unit: A Review of the Literature

Abstract

The bispectral index is a technique that involves assessing brain activity (through electroencephalography as well as electromyography), and has been proposed to be useful for the detection of pain among patients who are unable to communicate verbally. This review aimed to clarify whether the bispectral index is an appropriate tool to assess pain in the intensive care unit.

Autonomic response during bladder hydrodistention reflects the severity of symptoms in patients with bladder pain syndrome/interstitial cystitis

“…The anesthetic depth during hydrodistention was monitored by BIS, which could detect the presence of pain by measuring brain activity. In our study, BIS during hydrodistention was maintained consistently between 40 and 50 with analgesic drugs and this level of BIS is considered to represent a state of general anesthesia . Some patients demonstrated increased BIS with elevated BP and PR on the first session, and consequently, additional analgesic drugs were needed to maintain the BIS level.…”

“…In our study, BIS during hydrodistention was maintained consistently between 40 and 50 with analgesic drugs and this level of BIS is considered to represent a state of general anesthesia. 10 Some patients demonstrated increased BIS with elevated BP and PR on the first session, and consequently, additional analgesic drugs were needed to maintain the BIS level. However, even though BIS was maintained stably between 40 and 50 on the second session, exaggerated autonomic responses were also detected.…”

Bispectral Index Monitoring in Terminally Ill Patients: A Validation Study

“…Another variable measured during BIS monitoringdelectromyography of the forehead (EMG)dmay be of value for pain assessment. 44 Future research may incorporate EMG as an additional and probably relevant parameter for both sedation and pain assessment.…”

Changes in the Bispectral Index in Response to Loss of Consciousness and No Somatic Movement to Nociceptive Stimuli in Elderly Patients

“…[ 24 25 26 ] Furthermore, some studies demonstrate a potential link between the BIS value and nociceptive procedures,[ 4 5 10 ] and most of them conclude that nociceptive stimulation causes a significant increase in the BIS. [ 4 27 ] The most possible explanation is that nociceptive stimulus can increase the EMG activity of the facial muscles, especially the corrugator supercilii muscles, which is a specific facial expression of pain. [ 28 ] There is an overlap between the EMG activity and cortical activity that could influence the signals received by BIS device so that pain stimulation may increase BIS values by increasing EMG activity.…”