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1、BIS Training,BIS Technology Clinical Selling,Why Use BIS in Cardiac Cases?,Patient may have diminished cardiac functionBP compromisedChallenging to determine right dosage Primary concern: Cardiac function preservation,September 4, 2018 | Confidential,2 |,Likelihood of comorbiditiesBeta blockers? Dia
2、betes? Hypertension?If using beta blockers, heart rate response will be masked and it will be difficult to gauge level of consciousness,Going on pumpNo more hemodynamics, therefore primary gauge of determining level of consciousness not availableAlso cardiopulmonary bypass machines may dilute anesth
3、etics. Patient is usually cooled down and therefore requires less anesthetic. Lower EEG potentially requires less demand for hypnotics. But how much is the right amount?,Going off pumpBody temperature rising means increased demand on the brain. Concerns about whether patient can regulate their own B
4、P once off pump.,Exploring Value of BIS Monitoring in Cardiac Cases,September 4, 2018 | Confidential,3 |,Why use BIS Monitoring in Total Knee Cases?,September 4, 2018 | Confidential,4 |,Use of tourniquet with GAObstructed blood flow (ischemia).Over time, increase in BP. (Clinicians are taught that t
5、he increase in BP is due to tourniquet pain a response of the sympathetic nervous system and not necessarily a level of consciousness issue.)Increase/decrease in BP may or may not be indicative of state of consciousness.,If tourniquet pain might cause increase BP, are you 100% certain there isnt a c
6、hange in level of consciousness?Challenging to determine what are true anesthetic needs.,Exploring the Value of BIS Monitoring in Total Knee Cases,September 4, 2018 | Confidential,5 |,Why Use BIS Monitoring in Laparoscopic Abdominal Surgeries?,September 4, 2018 | Confidential,6 |,Surgeon puts (insuf
7、flates) CO2 (gas) into the abdomen (pneumoperitoneum) to gain access to the areaBP may increase with pneumoperitoneum. (Clinicians are taught that increased BP is a result of insufflation and not a level of consciousness issue.)Increase/decrease in BP has nothing to do with consciousness. How do you
8、 truly know anesthetic needs?,NMB typically usedPatient paralyzed.Cannot use movement as an indicator of patient lightening.What happens if you address the wrong issue?,Exploring the Value of BIS Monitoring in Laparoscopic Abdominal Surgeries,September 4, 2018 | Confidential,7 |,Why Use BIS Monitori
9、ng in Open Abdominal Surgeries?,September 4, 2018 | Confidential,8 |,NMB most likely usedPatient paralyzed.Cannot use movement as an indicator of patient lightening. If there is an increase in BP, how does one determine if it is a pain or level of consciousness issue?What happens if you address the
10、wrong issue?,EpiduralPotential use of epidural for postoperative pain management may result in more factors influencing BP and decrease the anesthetic requirement.,Exploring the Value of BIS Monitoring in Open Abdominal Surgeries,September 4, 2018 | Confidential,9 |,Why Use BIS Monitoring in Spine C
11、ases?,September 4, 2018 | Confidential,10 |,TIVA technique more likelyNo end-tidal, which means it is difficult to determine drug level in patient. (Remember: Drug levels do not equate to drug effect.)How do you know if patient is adequately anesthetized?,Patient might have chronic pain and history
12、of opioid tolerance (pain medications)Even more challenging to determine anesthetic needs.,Potentially long casesPotential for anesthetic accumulationChallenging to balance anesthetic needs knowing case might be over soon and need to wake up patient rapidly.,Exploring the Value of BIS Monitoring in
13、Spine Cases,September 4, 2018 | Confidential,11 |,Why Use BIS Monitoring in Elderly Cases?,September 4, 2018 | Confidential,12 |,Likelihood of comorbiditiesHypertension? Diabetes?If using anti-hypertensives, hemodynamics will be masked, and it will be difficult to gauge level of consciousness. BP re
14、sponse may be exaggerated.,Dosage? How much does an elderly and potentially frail person need?Too much might have a delayed wake-up and/or increase probability for hypotension.Too little might have increased potential for awareness.,Exploring the Value of BIS Monitoring in Elderly Cases,September 4,
15、 2018 | Confidential,13 |,Why Use BIS Monitoring in Bariatric Cases?,September 4, 2018 | Confidential,14 |,Increased likelihood of comorbiditiesHypertension? Diabetes?If on BP medications, hemodynamics will be masked and it will be difficult to gauge level of consciousness.,Intubation challengesPote
16、ntial for difficult airway.Might lose track of other things (potential for awareness). Prolonged attempts/difficulty intubating increases risk for awareness.,Difficult to determine correct dosage (high weight doesnt necessarily mean increased dosage)How do you determine correct dosage, particularly for intravenous agents?,Emergence challengesIdeally want a full and rapid emergence so that patient maintains own airway after extubation.,
