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Editor's Page
Brain Monitors or Awareness Monitors?
Dan O'Connor
Publish Date: October 10, 2007

Dan O The brain monitor's search for a problem to solve may be over, and all because the phrase you never heard before is suddenly everywhere you look.

Anesthesia awareness.

Dan O For as long as the brain monitor has been around, it's been thought of as a way to prevent you from over-medicating patients and delaying recovery, a nice-but-not-necessary OR accessory that boldly aspires to precisely measure consciousness during surgery so that you could perfect the dose of anesthetic you give.

But did you really need another machine to make sure that you gave patients not too little, not too much, but just the right amount of anesthetic? Up to this point, six out of 10 ORs got by just fine without relying on a brain monitor to tailor doses of anesthesia, apparently unmoved by the prospect of dramatically improving the safety and quality of patient care during and immediately after surgery, and maybe even reducing post-op mortality rates in the long term.

Deep anesthesia is harmful, studies have shown, but it's nothing compared to the terrifying tales of patients who have woken during surgery, unable to move, speak or scream. Of one woman who felt surgeons' tugging to remove her diseased eye. Of another woman who could recite her surgeon's OR cell phone call. With intraoperative awareness as hot a topic as it is, and with (company-sponsored) studies showing the monitors can reduce the incidence of awareness, we have an interesting about-face on how you might view the monitor: Now it's a way to prevent you from under-medicating patients and causing awareness.

Brain monitors help prevent both over- and under-sedation, but isn't the problem of too-little anesthetic a more compelling reason to use a monitor than too-much anesthetic is - even if awakening happens in one or two of every 1,000 cases?

The American Society of Anesthesiologists declined to mandate the routine use of monitors when it approved the group's first standards on preventing anesthesia awareness at its annual meeting last month. Use them at your discretion, suggests the ASA.

A tepid endorsement, to be sure. But backed by public hoopla; an FDA-approved labeling change that let Aspect Medical, the manufacturer of the market-leading Bispectral Index monitor, say that its monitors "may be associated with the reduction of the incidence of awareness with recall in adults during general anesthesia and sedation"; and a JCAHO alert aimed at reducing anesthesia awareness, the brain monitor may have finally found its reason for being: anesthesia awareness.