PHOENIX, AZ – Maintaining vigilance is vital for an Anesthesiologist or CRNA taking care of patients undergoing surgery. However, vigilance is greatly tested every day in the operating room when da Vinci robots are rolled in, free flap cases are booked, or that really slow general surgeon allows the even slower intern to close. A novel patient safety idea was proposed to start monitoring anesthesia providers during cases in order to ensure adequate brain activity of the Anesthesiologist/CRNA during a patient’s case.
“The best part of this new program is that the monitor already exists today,” stated Anesthesiologist Dr. Anna Wilkers. “The BIS monitor was created and designed to monitor EEG brain signals of patients under anesthesia to prevent intraoperative awareness. Inconclusive data and skepticism caused initial excitement for the BIS monitor to wane over the years.”
Dr. Frank Rochers, President of The American Society of Anesthesiologists, released a new practice advisory in regards to the BIS monitor. “Making sure our patients are asleep during surgery is very important, but even more important is making sure the Anesthesiologist or CRNA is awake. We now have added BIS monitoring to the standard ASA monitors, but just make sure to put the electrodes on yourself instead of the patient.”
When an Anesthesiologist or CRNA falls asleep in the OR, their BIS score will fall and the monitor will alarm which will wake up 90% of providers. However, if the provider stays asleep during the alarms, it will be the responsibility of the operating room nurse to gently come over and wake the provider up, with emphasis on being gentle. New ideas are being floated around to wire the twitch monitor in the room to “shock” the provider awake again automatically.
An incidental finding demonstrated that Anesthesiologist/CRNA BIS scores also plummeted when nurses asked for room times or when they found out that a medical student had been assigned to the room.
