Got the disclaimer - thanks - you're one of the few people I've seen so adamant about BIS that's not on Aspect's payroll.
I don't recall that it took 3000 papers or 10-12 years to show the benefits of EKG's, SaO2, or EtCO2 monitoring. The fact that after this long it's still a hotly debated topic ought to indicate something to even a casual observer outside the medical field.
When I started in anesthesia, it was EKG, BP, and precordial. It took me about an hour of trying SaO2 and EtCO2 monitors when they first came out to be totally convinced they were worthwhile (I never read a study about either of them), and perhaps a month or two to be convinced that more often than not, the numbers were right and I wasn't. I've tried BIS for months in several different practice settings over the last few years and I just can't see that it makes any difference whatsoever. And hey, I love new toys and gadgets as much or more than most, but BIS just doesn't excite me.
On top of that there's the sleazy sales and PR tactics of Aspect, and their obnoxious and condescending sales reps that would rather just tell you you're stupid for not using BIS because "everyone else is" and "you'll get sued if you don't have it". Their reps just blow off questions and studies that indicate BIS is of little value - I think that's because they're only capable of regurgitating what they've been taught from Aspect and incapable of actually answering straightforward questions that are at odds with their company's propaganda line. We've never had a rep from any company for any product we use in the OR that we dislike more than the Aspect reps that have come through (and the physician "experts" they tote along with them).
You are definitely missing many salient points:
" I don't recall that it took 3000 papers or 10-12 years to show the benefits of EKG's, SaO2, or EtCO2 monitoring. "
Maybe because vital signs are 'vital?' We have 'worshiped' trends in vital signs as a means of assessing depth of anesthesia. Hence, there is
no challenge to our belief system.
Several issues with brain activity monitoring:
1) Brain activity monitoring challenges our most deeply held belief that trends in vital signs clue us in to depth of anesthesia.
2) Since we already 'know' how asleep the patient is, why would we want a monitor to 'tell' us? It's redundant, right.
3) Hey, we're not killing anybody, so what's the issue?
4) Pssst, don't say it too loudly, but, if they have a machine that can tell you how asleep the patient is, what would they want us for?
(Luddite 2.3)
5) BIS won't put any more money in my pocket, why should I bother? No less call, no more vacation, no shorter workday. Besides, it's one more thing to learn and incorporate into my clinical pathway.
"I've tried BIS for months in several different practice settings over the last few years and I just can't see that it makes any difference whatsoever."
Gold star for trying
but I doubt you tried trending EMG as a secondary trace. EMG gives you the ability to respond to instantaneous changes. I find it very useful in my practice.
"And hey, I love new toys and gadgets as much or more than most, but BIS just doesn't excite me. "
Dr. Gadget here. BIS excites me for the titration of my propofol. It's like taking an 'open book' test.
"... the sleazy sales and PR tactics of Aspect,..."
As an early technology adopter, I was never subjected to such behavior, assuming what you say is true and you've never lied to me before..
What part of being able to directly measure (OK, algorithm) the organ you are medicating is so difficult for you to imagine could be useful? Not perfect, but useful. If I had anything to do with the financial success of the company, I would apologize. Since I don't, I won't. As far as the different personalities one encounters in life, some sales reps are better than others, some anesthesiologists are better than others.
C'est la guerre.
Yours for better published and reproducible outcomes,
aghast1
