Anesthesiologists: Brain monitors aren’t standard
Anesthesiologists: Brain monitors aren’t standard
Association approves report on awareness
A newly approved report on intraoperative awareness from the American Society of Anesthesiologists (ASA) says that depth-of-anesthesia monitors are not standard, but that they should be available for cases that may be high risk, such as cardiac cases. The ASA House of Delegates also passed a recommendation that ASA study funding further research into the usefulness of brain function monitoring technology in minimizing the risk of intraoperative awareness.
The report says, "the decision to use a brain function monitor should be made on a case-by-case basis by the individual practitioner for selected patients."
"My conclusion is that there are certain patients we would be well advised to use such a monitor on," says Orin F. Guidry, MD, ASA president and staff anesthesiologist at Ochsner Clinic Foundation in New Orleans. Such monitors should be considered as part of the "constellation of monitors available to us," he adds. Guidry spoke at a recent media conference call about the report.
Will there eventually be one in every OR? "Each institution will have to answer that on its own," he replies.
The incidence of intraoperative awareness has been reported as one to two cases per 1,000 surgeries under general anesthesia, and cases has been highly publicized in recent years, the ASA says. Although many cases are brief, some are significant or traumatic for the patient, the ASA reports.
In Guidry’s practice, 5%-10% of patients express concern about awareness, he says. "They could be reassured if we would use such a monito. They may not be at high risk, but they would be comforted to know such monitors are available." Some facilities can work out arrangements with vendors to have the monitors provided and pay for electrodes, which cost $15-$25 per patient. "From the cases I’ve seen, that’s a reasonable cost to prevent one case of awareness," Guidry says. The electrodes cost is a "drop in the bucket" compared to total OR costs, he notes.
The report says anesthesia providers should rely on multiple modalities related to monitoring patients for awareness. Those modalities include clinical techniques — for example, checking for clinical signs such as purposeful or reflex movement — and conventional monitoring systems such as electrocardiograms, blood pressure monitors, heart-rate monitors, end-tidal anesthetic analyzers, and capnographs.
Providing a lighter-than-normal anesthetic to at-risk patients may be a necessary step, and that possibility generally is discussed with patients in advance of surgery if circumstances permit, the report says. Guidry says, "Not all cases of awareness can be prevented. It’s more important to keep the patient alive and well."
The only drawback to using depth of anesthesia monitors is if they aren’t used in an intelligent fashion, Guidry says. For example, an anesthesia provider shouldn’t rely solely upon a monitor and should look for signs that a patient may not be adequately anesthetized, he says. "The literature indicates that a patient may be aware even when a brain function monitor indicated that the depth of anesthesia was adequate."
Associating to the ASA, the report, Practice Advisory for Intraoperative Awareness and Brain Function Monitoring, represents the most thorough document to date to assist anesthesia professionals and surgery providers in minimizing the risks of awareness under general anesthesia. (See summary of report. To access the report at no cost, go to www.asahq.org/publicationsAndServices/Aware AdvisoryFinalOct05.pdf.)
A newly approved report on intraoperative awareness from the American Society of Anesthesiologists (ASA) says that depth-of-anesthesia monitors are not standard, but that they should be available for cases that may be high risk, such as cardiac cases.Subscribe Now for Access
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