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Related Concept Videos

Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
Subconsciousness and No Awareness01:15

Subconsciousness and No Awareness

The concept of subconscious awareness refers to the processing of information below the level of conscious thought, which significantly influences both behaviors and decisions. It is also known as waking subconscious awareness. This complex level of cognition operates without the direct awareness of the individual, facilitating rapid and simultaneous handling of multiple information streams.
An illustrative example of subconscious processing is its role in problem-solving. Often, individuals...
Sedatives and Hypnotics: Overview01:23

Sedatives and Hypnotics: Overview

Sedatives are drugs that alleviate anxiety, while hypnotics induce sleep. Both classes of medication suppress neuronal activity, leading to a calming effect for sedatives and facilitating sleep for hypnotics.
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Related Experiment Video

Updated: Jul 6, 2026

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
07:54

Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea

Published on: December 6, 2016

Anesthesia awareness and the bispectral index.

Michael S Avidan1, Lini Zhang, Beth A Burnside

  • 1Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA. avidanm@wustl.edu

The New England Journal of Medicine
|March 14, 2008
PubMed
Summary

This study found no difference in anesthesia awareness between bispectral index (BIS) monitoring and end-tidal anesthetic gas (ETAG) monitoring. Routine BIS monitoring is not supported by these findings.

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Area of Science:

  • Anesthesiology
  • Neuroscience

Background:

  • Anesthesia awareness is a serious complication with potential psychological sequelae.
  • Previous studies suggested bispectral index (BIS) monitoring may reduce anesthesia awareness.
  • This study investigated BIS versus end-tidal anesthetic gas (ETAG) monitoring for high-risk patients.

Purpose of the Study:

  • To compare the efficacy of BIS-guided anesthesia versus ETAG-guided anesthesia in preventing anesthesia awareness.
  • To determine if BIS monitoring reduces the incidence of anesthesia awareness in high-risk surgical patients.

Main Methods:

  • 2000 high-risk patients were randomized to BIS-guided (target 40-60) or ETAG-guided (target 0.7-1.3 MAC) anesthesia.
  • Anesthesia awareness was assessed postoperatively at 0-24 hours, 24-72 hours, and 30 days.

Main Results:

  • Two cases of anesthesia awareness occurred in each group (BIS and ETAG), showing no significant difference.
  • Awareness events occurred despite BIS values within target range or ETAG concentrations below 0.7 MAC.
  • No significant difference in time-averaged ETAG concentrations between the BIS and ETAG groups.

Conclusions:

  • This study did not replicate previous findings of reduced anesthesia awareness with BIS monitoring.
  • BIS monitoring was not associated with reduced volatile anesthetic administration.
  • Findings do not support routine BIS monitoring in standard anesthesia practice.