Through the looking glass: awareness, BIS and an anaesthetist's perspective

Accidental awareness under general anaesthesia (AAGA) is the stuff of nightmares for patients and anaesthetists alike. Data from NAP5 has demonstrated a relatively low incidence incidence of AAGA but recommendations from the project include the use of depth of anaesthesia monitors in at risk groups. This recommendation was preceded by esoteric guidance from NICE that BIS monitors were an 'option' for a broad and loosely defined group of patients. BIS is a proprietary technology and as such, we do not know exactly how it derives the value it displays. In 2003 a very small study (n=3) found that the BIS index could be made to drop to alarmingly low levels by administering suxamethonium alone without a hypnotic agent. This study has remained something of a curiosity and has never been replicated or further explored until now. In this special edition podcast, Peter Schuller talks to us about his impressive work and the truly astounding results it has produced. Whilst his study generates more questions than is answers with regard to BIS monitoring, a fascinating by-product is the insight into awareness which he has documented and shares with us in this podcast.

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