Awake-During-Surgery Device Worth a Nod?
Study Challenges Benefit of BIS, a Brain Monitor That Helps Doctors Detect When Patients Are Waking
Does BIS Brain Monitor Cut Waking During Surgery? continued...
But Scott D. Kelley, MD, vice president and medical director for Aspect Medical Systems Inc., sees the Avidan study much differently.
Kelley notes that the rate of anesthesia awareness seen in the study was about two per 1,000 patients -- 10 times lower than would be expected for these high-risk patients. This, he says, shows that BIS monitoring does indeed reduce waking during surgery.
"What they used as a control protocol is not standard practice," Kelley tells WebMD. "I went through 40 operating rooms yesterday, and not a single one had one of these exhaled gas alarms turned on. So what the control group received in the Avidan study was not the kind of care the average patient can expect to get. I don't want patients to believe that starting tomorrow they will get same kind of care the control group got in the Avidan study. And are there other consequences to that kind of treatment care? We don't know. Their protocol has not been validated in clinical trials."
Kelley also brushes aside Orser's criticism of what the Aspect BIS monitor measures.
"There are clearly deep structures within the brain where some of these control centers for consciousness exist. But as clinicians trying to take care of a wide number of patients, what is important here is the surface reading of the electroencephalogram," he says. "We have broad clinical experience in more than 25 million patients. This technology being adopted by so many doctors works, and works well, and has patient impact. I believe I, as an anesthesiologist, and my patients benefit greatly from this technology."
What Anesthesiologists Tell Patients About Waking During Surgery
Orser worries that efforts to promote the BIS monitor are unduly alarming patients.
"This worry about anesthesia awareness is really frightening our patients, more than is in their interest," she says. "It is disappointing this device isn't the silver bullet for treating this. But I reassure patients that the incidence of anesthesia awareness is very low."
Avidan advises anesthesiologists to discuss the issue with patients prior to surgery and to urge patients to contact their doctors if they have uncomfortable memories after surgery.