Awareness Movie “Awake”

[huron]

“Awake”

There is a new movie about awareness opening on November 30, whose movie trailer is now available on the web.

"During surgery, more than 60,000 people domestically each year experience "anesthetical awareness," a condition when anesthesia fails during surgery, leaving one completely conscious and feeling every incision, but paralyzed and incapable of doing anything about it. This is what happens to Clay. "
-yahoo.com movies

Staring Jessica Alba and Hayden Christensen.

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Members don't see this ad.

 

[gasnewby]

oh god. pts are going to be insufferable.

 

[cchoukal]

I was told this was already released and basically went straight to DVD... could be wrong...

 

[cfdavid]

here's the link and trailer.

http://www.awakethemovie.com/

 

[Bertelman]

“Awake”

There is a new movie about awareness opening on November 30, whose movie trailer is now available on the web.


Staring Jessica Alba and Hayden Christensen.

Not so new...Was supposed to be released in actual ...ahem...theaters earlier this year...

http://forums.studentdoctor.net/showthread.php?t=384777&highlight=awake

 

[bullard]

imdb.com lists the following release dates:

USA 27 September 2006 (limited)
USA 26 February 2008
UK 29 February 2008
Argentina 8 May 2008

 

[CremeSickle]

Now i have to fight my desire to see Jessica Alba in a movie with my professional distaste.....


I might have to go see it...

 

[ecCA1]

The movie implies that his awakeness is simply a by-product of their belief that he'd be dead, not that most anesthesiologists put people to sleep for sternotomies with panc and a bit of thio up front.

Looks like the standard "your friends aren't who they appear to be" flick that will bomb, Jessica Alba starring in it or not.

 

[maikmd]

To use BIS for monitoring intraop awareness is expensive from where I come from. It's more expensive than the use of the anesthesiology machine itself.
So far, none have yet complained of having intraop awareness post-op, except there were a couple of patients in my preop evaluation who claimed to have intraop awareness in their previous surgery. maybe it was during emergence or really intraop awareness, we couldn't be sure.

 

[Gern Blansten]

People that report awareness when questioned aren't that uncommon. Most, upon further questioning, turn out to be from colonoscopies or some other MAC procedure. I have found it very rare to find a patient who complains of previous awareness under anesthesia during the preop eval to have actually had a "real" episode of awareness. Unfortunately, it does happen. But if you fail to ask the right questions, you may be fooled into thinking it is more common than it really is. That has been my experience. Any thoughts?

 

[DrMunkey]

Jeez... we are going to be having some hysterical family members, patients, friends, and I'm sure even some colleagues in other specialties to have to deal with for a while. I don't believe that statistic, the "1 in 700 remain awake." I guess they lumped all colonoscopies and procedures done under MAC or regional in with that? That's all I can think of that would skew it that much.

 

[powermd]

here's the link and trailer.

http://www.awakethemovie.com/

That was freakin' ******ed. It would be better if this concept were somehow integrated into Saw 4.

 

[epidural man]

“Awake”

There is a new movie about awareness opening on November 30, whose movie trailer is now available on the web.

"During surgery, more than 60,000 people domestically each year experience "anesthetical awareness," a condition when anesthesia fails during surgery, leaving one completely conscious and feeling every incision, but paralyzed and incapable of doing anything about it. This is what happens to Clay. "
-yahoo.com movies

Staring Jessica Alba and Hayden Christensen.

Damn, it really is coming out? I sold my Aspect Medical stock ages ago because I thought this movie was never coming out. I bought thinking that the movie would scare hospitals into purchasing the equipment. It will be interesting to see what happens to the stock price when the movies runs. I heard it sucked.

 

[epidural man]

Just watched the trailor....that jessica alba looks stunning as always.

The movie looked kinda dumb. How can you make a whole movie based on remembering your surgery?

 

[fakin' the funk]

Damn, it really is coming out? I sold my Aspect Medical stock ages ago because I thought this movie was never coming out. I bought thinking that the movie would scare hospitals into purchasing the equipment. It will be interesting to see what happens to the stock price when the movies runs. I heard it sucked.

I think you may be SLIIIII-I-I-GHTLY overestimating the impact of this movie on the real world.

I mean, anesthesia providers know about awareness...but does anyone else? Does anyone else care? Do patients even know what medical problems they have, or why they're having surgery in the first place? I suspect the answer is NO.

 

[epidural man]

I think you may be SLIIIII-I-I-GHTLY overestimating the impact of this movie on the real world.

I mean, anesthesia providers know about awareness...but does anyone else? Does anyone else care? Do patients even know what medical problems they have, or why they're having surgery in the first place? I suspect the answer is NO.

You are absolutely correct. Most don't have any idea, but they will if they see the movie. They will have an idea, albeit the wrong one, but it will get people thinking about awareness more than they have previously - but only if the movie was good and people actually went to see it. I doubt it will be a blockbuster hit. Don't underestimate the power that media has over decision people make. If lots of people see it, they will start to ask hospitals about awareness monitors and administrators will feel the need to buy monitors. I don't think this is a stretch. This is why drug companies started putting commercials on because it is very effective to have the patient ask the doctor "what about this drug?"

 

[Bertelman]

You are absolutely correct. Most don't have any idea, but they will if they see the movie. They will have an idea, albeit the wrong one, but it will get people thinking about awareness more than they have previously - but only if the movie was good and people actually went to see it. I doubt it will be a blockbuster hit. Don't underestimate the power that media has over decision people make. If lots of people see it, they will start to ask hospitals about awareness monitors and administrators will feel the need to buy monitors. I don't think this is a stretch. This is why drug companies started putting commercials on because it is very effective to have the patient ask the doctor "what about this drug?"

Any effect this movie has on the collective psyche of the population will last about as long as the headlines last, which is maybe a day or two. After that, no one will remember. Just like we forget every other public outcry and media uproar, because they are quickly replaced by the next "big" story.

Now consider hospital policy. For any substantial purchase to occur, it must be included in the annual departmental budget. It's now November. Either the fiscal year has passed, and the budget is already spent/assigned, or the fiscal year will be here in two months, in which case the budget is finalized/approved. So now we're talking another 9 months before several hospitals can mobilize enough capital to make a purchase big enough to drive up your stock price.

Again, this is a movie with a bad storyline, sexy actors, months distant from a previously bailed release date. Chance you will see any lasting effect in 2008? Nil.

 

[cchoukal]

This is the email on this issues I just received from the president of the ASA:

To: ASA Members
ASA Staff

From: Jeffrey L. Apfelbaum, M.D., President
Dawn Glossa, Director of Communications


As many of you may have seen the movie AWAKE will open in theaters nationwide on November 30, 2007. The movie tells a story of a young man undergoing heart surgery who experiences anesthesia awareness. Although we have not previewed the movie, our sources and the information available tell us the portrayal of the profession is not positive.

While our immediate reaction may be to become upset, the ASA Communications Department is asking you to remain calm regarding the movie and follow the guidelines below:

If you are contacted by the media, please refer them to the ASA Communications Department at 847-268-9110. We will be happy to accommodate their questions.

If your patients ask you about the movie or awareness, please refer to ASA’s brochure regarding awareness (www.asahq.org/patientEducation/Awarenessbrochure.pdf). Our goal is to not inadvertently publicize the movie for the movie company. They may attempt to “egg us on” with incorrect or inflammatory statements and try to get us to respond. Remember that any media attention on the topic will create publicity for the movie, which in turn, encourages people to see the film.

Proactively ASA’s communications department will be running a concurrent campaign on educating the public about the medical specialty of anesthesiology. It will be an important component to combat the negative publicity this movie could create.

If you have any questions or concerns, you should feel free to contact the ASA Communications Department at any time. The contact information is as follows:

Dawn Glossa
ASA Director of Communications
847-268-9110 (office)
773-610-2554 (cell)
[email protected]

 

[Cleonymus]

In regards to that movie about intraop awareness... I think people make a big deal out of it. Ok.. so, they remember.. and? Nothing happened. They are alive. It's a traumatic experience, their fabric psych is not well because it happened... well? Yeah, like they went through a D-day landing in Omaha beach, right? Now, that's traumatic. People are no longer tough like old folks from previous generations. Nowadays, people are not to feel anything... no pain, no complications... all perfect. People have PTSD from trivial things like not having toilet paper soft enough or the right wall colors to match their wine rack or their kids not getting their playstation and X-Box combo hooked up to a 7.1 surround sound fast enough for them to enjoy. That goes to show you the producers and distribuitors of that film are profoundly ignorant about medicine and the potentially negative medico-legal consequences in their quest to make money at all cost. Just think that people are looking for any excuse to sue their doctors to make a quick buck. How can you prove someone didn't have intraop awareness and that they did not experience pain and suffering because of it? Soon we will see websites like "doyourememberyoursurgery.net" or "call 1-800-SUEYOURDOC.COM if you remember having surgery", etc, etc. I think people should know that "it's expected in special circunstances to remember their surgery, but it is very rare and will not affect them in anyway" Don't make it sound like some kind of Vietnam or Dachau concentration camp experience.

 

[Ferdie]

People are no longer tough like old folks from previous generations. Nowadays, people are not to feel anything... no pain, no complications... all perfect. People have PTSD from trivial things like not having toilet paper soft enough or the right wall colors to match their wine rack or their kids not getting their playstation and X-Box combo hooked up to a 7.1 surround sound fast enough for them to enjoy.

This is why I love my old German-Norwegian farmers up in this neck of the woods. They complain about NOTHING! I walked into this nice old guy's room today and his Alaris pump was beeping (that drives me crazy immediately). I asked, "has this been doing that for long?" He said, "oh, just for the last couple hours or so, I didn't want to bother anyone."

I am doing acute pain service right now. It seems like half my patients are stoic German-Norwegian farmers, which makes my job VERY EASY. It seems like the other half are chronic pain-ers who just had surgery, and that's less easy...

 

[BLADEMDA]

YOu need to see the trailer on Yahoo. This is the "Jaws" for the Aneshesia world. Now, the real AWAKE figure is 1 in 15,000 with the vast majority being PUMP cases or Provider error (empty vaporizer, etc.) That is the figure you should tell patients and make them aware that Hollywood is not interested in FACTS.

For my Pump patients I tell them (if they are concrened) that a special monitor will be used to help decrease the chance of awareness (much, much less than 1 in 15,000).

Blade

 

[halflife94]

BLADE ...good to see you back...wasn't sure if you were still posting

 

[morpheus md]

All I know is that I am "aware" that Jessica Alba is fine as hell.

 

[Voodoo]

This particular film was touted as "...doing to surgery what Jaws did to swimming..."

If you haven't yet, watch the trailer. It sounds like in addition to the anesthesia awareness there's some sort of illegal activity that's taking place that the main character gets clued into. Hopefully that plot line will help audiences realize that a lot of this is fiction.

Think about it this way --- how many people here (especially residency-age) remember the movie "Coma" about some surgeon killing patients in a particular operating room? I guarantee not as many as "Jaws." While not quite the same subject, I hope that people will view this new film as something along the lines of that Coma movie.

My only question is where in the heck did they get that totally fallacious statistic of 1 in 700 experiencing anesthesia awareness?

 

[LostTommyGuns]

All I know is that I am "aware" that Jessica Alba is fine as hell.

I concur doctor.

My gut tells me that this won't be a long lived phenomenon but what it will do is scare the piss out of those people who are prone to having the piss scared out of them. You know the ones I mean - hell this could be a good thing... Maybe I'll get to use those people skills people always tell me that Anesthesiology is wasting!

 

[Idiopathic]

this is way different that i thought it would be. obviously the doctors are the bad guys, but i was under the impression it would be a negligence issue causing the awareness, not an issue of malice.

most people realize that most doctors are not malicious, but plenty of people think we are incompetent.

 

[Bougie]

I saw Apfelbaum's statement on "Awake" a week or so ago and thought it was ridiculous. Please tell me that the president of our professional society didn't actually use the phrase "egg us on."

 

[bareknuckles]

well unlike most of the people in here i am very happy with the movie .. you are all screaming CRNA are taking our jobs ..lol .. i bet that every patient will refuse an anesthesia from someone other than an anesthesiologist from now on

 

[zippa]

AWAKE is really giving some bad publicity and misinformation to the public about the field of anesthesiology. I was watching "The View" this morning and they had one of the stars on the show talking about the movie. Joy asked, "Does this really happen in real life" and the star and another co-host responded with " this happens ALL the time", "You shouldn't watch the movie if you are about to go under surgery" and "make sure you have the best anesthesiologist when you get surgery done." Kind off scary for viewers and the general public.

 

[Bertelman]

AWAKE is really giving some bad publicity and misinformation to the public about the field of anesthesiology. I was watching "The View" this morning and they had one of the stars on the show talking about the movie. Joy asked, "Does this really happen in real life" and the star and another co-host responded with " this happens ALL the time", "You shouldn't watch the movie if you are about to go under surgery" and "make sure you have the best anesthesiologist when you get surgery done." Kind off scary for viewers and the general public.

FWIW, I'd be pretty cautious/suspicious of any patients that listens to the blab on The View.

 

[OB1🤙]

"make sure you have the best anesthesiologist when you get surgery done." Kind off scary for viewers and the general public.

I think this is a good thing.

 

[zippa]

I think this is a good thing.

I agree. I was mostly worried about the statement that "anesthesia awareness happens all the time." They made it sound like 1 in10 operations had this happen.

FWIW, I'd be pretty cautious/suspicious of any patients that listens to the blab on The View.

Unfortunately most people will believe a lot of the stuff they hear on TV.

 

[fakin' the funk]

I was watching "The View" this morning and they had one of the stars on the show talking about the movie....Joy asked...Kind off scary for viewers and the general public.

The beasts who host that show are the scariest thing about your post.

 

[coprolalia]

This movie will be stupid. And, it will flop. It's been teetering on the brink of a "straight to DVD" release for the past two years. Don't worry. Sure, you'll have to answer a few more questions and do a little more reassuring for the next couple of months or so, but with the nanosecond attention span of the American public, that'll be about the long and short of it.

-copro

 

[Planktonmd]

You just say to the patient who asks more questions:
Listen, there is a chance you might be aware under anesthesia like in the movie but I am going to put a stupid sticker on your head connected to a machine that produces random numbers, and give some of your money to a great company called Aspect, so if you happen to be aware you can't sue me. I hope that is ok with you because otherwise I can't give you anesthesia.

 

[aghast1]

posts reveal disappointing, luddite attitudes toward the subject

my patients like the idea that i am monitoring the organ i am medicating

we are not trying to anesthetize the heart rate/blood pressure

the brain is the target organ

as one past asa president remarked, 'why would you not want to use the monitor?'

for those interested in the topic www.anesthesiaawareness.com

fwiw, awareness is not nearly the problem of routinely overdosing patients

monk (@ duke) and sebel (@emory) have shown deleterious effects of too much anesthesia

'goldilocks' anesthesia is that which is neither too deep nor too light, but just right

some may find the moniker 'goldilocks' unbearable.'

one cannot know how deep the patient without a level of consciousness monitor

no competitors to bis have demonstrated superiority, though a few claim parity

the dirty little secret aspect does not tell prospective bis users is to trend emg (instantaneous) as a secondary trace

respond to spikes in emg as if they were changes in heart rate and blood pressure and you will find the monitor is of enormous value

also, bis makes each patient their own 'video game' and greatly adds to the interest in ones day

fwiw, the facetious comment @ last asa was wondering how much it cost nassib, ceo aspect, to keep 'awake' from premiering during asa.

 

[Planktonmd]

posts reveal disappointing, luddite attitudes toward the subject

my patients like the idea that i am monitoring the organ i am medicating

we are not trying to anesthetize the heart rate/blood pressure

the brain is the target organ

as one past asa president remarked, 'why would you not want to use the monitor?'

for those interested in the topic www.anesthesiaawareness.com

fwiw, awareness is not nearly the problem of routinely overdosing patients

monk (@ duke) and sebel (@emory) have shown deleterious effects of too much anesthesia

'goldilocks' anesthesia is that which is neither too deep nor too light, but just right

some may find the moniker 'goldilocks' unbearable.'

one cannot know how deep the patient without a level of consciousness monitor

no competitors to bis have demonstrated superiority, though a few claim parity

the dirty little secret aspect does not tell prospective bis users is to trend emg (instantaneous) as a secondary trace

respond to spikes in emg as if they were changes in heart rate and blood pressure and you will find the monitor is of enormous value

also, bis makes each patient their own 'video game' and greatly adds to the interest in ones day

fwiw, the facetious comment @ last asa was wondering how much it cost nassib, ceo aspect, to keep 'awake' from premiering during asa.

First: BIS was never shown to prevent awareness.
Second: I didn't know that BIS monitors the "level of consciousness" and that without such a monitor you can't tell how "deep a patient is" whatever that means!
Third: EMG activity directly affects BIS numbers and makes it very unreliable in patients who are not paralyzed. This is what Aspect doesn't tell people!

This monitor is a tool that can be helpful sometimes, nothing more.

 

[aghast1]

First: BIS was never shown to prevent awareness.
Second: I didn't know that BIS monitors the "level of consciousness" and that without such a monitor you can't tell how "deep a patient is" whatever that means!
Third: EMG activity directly affects BIS numbers and makes it very unreliable in patients who are not paralyzed. This is what Aspect doesn't tell people!

This monitor is a tool that can be helpful sometimes, nothing more.

No one ever claimed prevention. BIS is documented to decrease the incidence of awareness by 82%. What part of 'decrease' do you imagine meant 'prevent'?

Ekman A, Lindholm ML, Lennmarken C, et al: Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 48:20, 2004.

I didn't know that BIS monitors the "level of consciousness" and that without such a monitor you can't tell how "deep a patient is" whatever that means!

Please see my previous post in the donde west thread.

Also if you do not know what 'level of consciousness' means I would be very concerned for your patients. BIS values below 45 are associated with decrease in one year survival rates as well as elevations in C-reactive protein levels, a marker for inflammation.

EMG activity directly affects BIS numbers and makes it very unreliable in patients who are not paralyzed.

None of my patients have been paralyzed since March 26, 1992. Used BIS since 12/26/1997 routinely. Began trending EMG in late 1998 and found it VERY useful for predicting patient movement (and typically the need for additional lidocaine in the field). EMG spikes upward instantaneously while BIS is affected later. It is the instantaneous spike that one should respond to as if it were a change in HR or BP.

Consider adding BIS c EMG. It is like an open book test instead of guessing.

 

[VentdependenT]

This movie will be stupid. And, it will flop. It's been teetering on the brink of a "straight to DVD" release for the past two years. Don't worry. Sure, you'll have to answer a few more questions and do a little more reassuring for the next couple of months or so, but with the nanosecond attention span of the American public, that'll be about the long and short of it.

-copro

I'm going to have all my patients watch it in the PAR before we roll back to the room. They can munch on bicitra nuggets.

 

[gasnewby]

BIS values below 45 are associated with decrease in one year survival rates as well as elevations in C-reactive protein levels, a marker for inflammation.

what is the relevance of CRP? (Not arguing, just wondering)

thanks.

 

[Planktonmd]

what is the relevance of CRP? (Not arguing, just wondering)

thanks.

No one knows!

 

[Planktonmd]

No one ever claimed prevention. BIS is documented to decrease the incidence of awareness by 82%. What part of 'decrease' do you imagine meant 'prevent'?

Ekman A, Lindholm ML, Lennmarken C, et al: Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 48:20, 2004.

I didn't know that BIS monitors the "level of consciousness" and that without such a monitor you can't tell how "deep a patient is" whatever that means!

Please see my previous post in the donde west thread.

Also if you do not know what 'level of consciousness' means I would be very concerned for your patients. BIS values below 45 are associated with decrease in one year survival rates as well as elevations in C-reactive protein levels, a marker for inflammation.

EMG activity directly affects BIS numbers and makes it very unreliable in patients who are not paralyzed.

None of my patients have been paralyzed since March 26, 1992. Used BIS since 12/26/1997 routinely. Began trending EMG in late 1998 and found it VERY useful for predicting patient movement (and typically the need for additional lidocaine in the field). EMG spikes upward instantaneously while BIS is affected later. It is the instantaneous spike that one should respond to as if it were a change in HR or BP.

Consider adding BIS c EMG. It is like an open book test instead of guessing.

All the data you are qouting is weak at best, and your personal experience is only supported by your own personal evaluation so it does not qualify as evidence based data.
Let's leave it at this for now.

 

[dhb]

People using a BIS on every patient are being tooled by companies in the medical marketing business. It's a piece of equipment, do you put a central line in every patient? i hope not...
I don't like the BIS because of this issue but i must admit that in can be useful in selected patients.

 

[aghast1]

All the data you are quoting is weak at best, and your personal experience is only supported by your own personal evaluation so it does not qualify as evidence based data.
Let's leave it at this for now.

The data I quoted were reported as statistically significant in a peer reviewed publication.

My personal experience is supported by my outcomes and the reproducibility of these outcomes by others.

C-reactive proteins as an inflammatory marker supports Monk's hypothesis that unnecessarily deep anesthesia and increased one-year mortality are created by an inflammatory process.

'Goldilocks' anesthesia (or minimally invasive anesthesia&#174 is neither too much nor too little, but 'just right.' The patients neither hear, feel, nor remember their surgical experience with the lesser trespass of sedation.

Chapter 1, Table 1-4
Propofol ketamine with bispectral index monitoring
Anesthesia in Cosmetic Surgery, Cambridge University Press 2007

BIS Level of Sedation/Anesthesia

98-100 Awake
78-85 Minimal ('anxiolysis') sedation
70-78 Moderate ('conscious') sedation
60-70 Deep sedation
45-60 with systemic analgesia
General anesthesia
<45 Overdosed

BIS monitored PK MAC or MIA is either moderate to deep sedation.
One cannot trespass minimally unless one knows how much one is trespassing on the patient's physiology.

FWIW, there is a 19-fold variation in propofol metabolism among individuals. Court MH, Duan SX, Hesse LM, et al:Cytochrome P-450 2B6 is responsible for interindividual variability of propofol hydroxylation by human liver microsomes. Anesthesiology 94:110, 2001.

Any propofol scheme based on body weight, age or blood levels cannot account for the above differences.

Variation in vital signs as an index of anesthetic depth is an outmoded belief system we promulgated to guide dosing when we could not have any direct measurement of the target organ.

I understand the 'black box' BIS algorithm is only comparing the individual patient to a database of 5,000 patients. Nonetheless, BIS guided anesthesia is infinitely preferable to guessing and having to compensate by at least 20-30% to prevent under-dosing and potential intra-operative awareness.

Lastly, anyone who would seriously equate placement of a central line (an invasive procedure with potentially serious complications) with the placement of a skin sensor (non-invasive with no reported complications) is on very shaky logical grounds. Excuse me if I misunderstood you were only speaking tongue in cheek.

Best regards,
I remain, yours for better outcomes,

aghast1 (as my other one was a diesel)

 

[dhb]

Chapter 1, Table 1-4
Propofol ketamine with bispectral index monitoring
Anesthesia in Cosmetic Surgery, Cambridge University Press 2007

BIS Level of Sedation/Anesthesia

98-100 Awake
78-85 Minimal ('anxiolysis') sedation
70-78 Moderate ('conscious') sedation
60-70 Deep sedation
45-60 with systemic analgesia
General anesthesia
<45 Overdosed

BIS is not affected by ketamine so how do you now that your BIS reading of 60 is not actually overdose in the presence of K??? not so goldilocks to me...

Lastly, anyone who would seriously equate placement of a central line (an invasive procedure with potentially serious complications) with the placement of a skin sensor (non-invasive with no reported complications) is on very shaky logical grounds. Excuse me if I misunderstood you were only speaking tongue in cheek.

No i was talking about price and the fact that it's just a tool with no proof on outcome...

 

[Cheisu]

this is way different that i thought it would be. obviously the doctors are the bad guys, but i was under the impression it would be a negligence issue causing the awareness, not an issue of malice.

most people realize that most doctors are not malicious, but plenty of people think we are incompetent.

Seriously. I'm not a doctor yet (I want to be a surgeon), but I know completely what you mean.

It's like doctors are the bad guys. I mean, WOW, 1 in (and i know it's not 700) people know they're awake? I mean, think about how many lives have been SAVED by doctors, not how many are saved and traumatized.

I mean, come on. When 1 physician/surgeon makes a mistake, there's all this hype and "oh! let's sue him/her!". But when they save untold amounts of people, it's like people just ignore it. They never get awarded for the good, only criticized for the bad.

 

[aghast1]

Chapter 1, Table 1-4
Propofol ketamine with bispectral index monitoring
Anesthesia in Cosmetic Surgery, Cambridge University Press 2007

BIS Level of Sedation/Anesthesia

98-100 Awake
78-85 Minimal ('anxiolysis') sedation
70-78 Moderate ('conscious') sedation
60-70 Deep sedation
45-60 with systemic analgesia
General anesthesia
<45 Overdosed

From dhb @ #45

"BIS is not affected by ketamine so how do you now that your BIS reading of 60 is not actually overdose in the presence of K??? not so goldilocks to me..."

Actually, there are some who feel that it is not possible to monitor propofol with BIS in the presence of ketamine. For clarification, try reading

The effect of a dissociative dose of ketamine on the bispectral (BIS) index during propofol hypnosis. (lead article) Journal of Clinical Anesthesia 11:4,1999.

posted on my web site www.cosmeticsurgeryanesthesia.com.

Lastly, anyone who would seriously equate placement of a central line (an invasive procedure with potentially serious complications) with the placement of a skin sensor (non-invasive with no reported complications) is on very shaky logical grounds. Excuse me if I misunderstood you were only speaking tongue in cheek.

dhb "No i was talking about price and the fact that it's just a tool with no proof on outcome..."

Did you miss the last 3,000 or so papers validating BIS over the past decade? Check out the bibliography @www.aspectms.com.

Did you miss post #38? If so, try reading:

Ekman A, Lindholm ML, Lennmarken C, et al: Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 48:20, 2004.

The outcome was an 82% reduction in the incidence of awareness was reported.

No technology is perfect not your NIABP, SpO2 or even EKG. BIS is no different.

Lastly, many from this site continue to visit my site. Thank you.

For those who might be interested:

‘AWAKE’ the movie highlights the need for ‘Goldilocks’ anesthesia," says developer of bispectral index (BIS) monitored propofol ketamine sedation, now trademarked as minimally invasive anesthesia(MIA)®.

will be posted on www.cosmeticsurgeryanesthesia.com Wednesday, November 28, 2007.

Remember, if you don't like my press releases, don't read them.

Best regards from warm & sunny southern California,

aghast1

PS Down coast from Malibu. No fires in OC this Santana.

 

[Planktonmd]

I think "Goldilocks" anesthesia belongs exclusively in southern California and in the hands of "cosmetic anesthesiologists".

 

[dhb]

From dhb @ #45

"BIS is not affected by ketamine so how do you now that your BIS reading of 60 is not actually overdose in the presence of K??? not so goldilocks to me..."

Actually, there are some who feel that it is not possible to monitor propofol with BIS in the presence of ketamine. For clarification, try reading

The effect of a dissociative dose of ketamine on the bispectral (BIS) index during propofol hypnosis. (lead article) Journal of Clinical Anesthesia 11:4,1999.

Did you read it yourself??? It offers no info on how to adjust the depth of anesthesia with ketamine it is just a description of your technique. What i'm saying (and you still haven't answered this) is that you say your doing a goldilocks anesthesia without knowing if you could be lighter on the propofol with ketamine on-board...

Did you miss the last 3,000 or so papers validating BIS over the past decade? Check out the bibliography @www.aspectms.com.

Ekman A, Lindholm ML, Lennmarken C, et al: Reduction in the incidence of awareness using BIS monitoring. Acta Anaesthesiol Scand 48:20, 2004.

The outcome was an 82% reduction in the incidence of awareness was reported.

I have not had a single case of awareness so i wouldn't benefit from an 82% reduction 0.2% of case that's friggin nuts!

No technology is perfect not your NIABP, SpO2 or even EKG. BIS is no different.

That's exactly what i'm saying

 

[jwk]

The outcome was an 82% reduction in the incidence of awareness was reported.

No technology is perfect not your NIABP, SpO2 or even EKG. BIS is no different.

.

Just curious - do you speak on behalf of Aspect and BIS - if so, where is your disclaimer?

And I'll happily go the rest of my career (27 years so far, at least 10-15 more to go) without using a BIS. The other monitors, while not "perfect" are much more reliable, dependable, predictable, reproducible, and USEFUL than BIS could ever hope to be. After 10 years (or more?) it's still a monitor in search of an indication that seeks to solve a problem that is largely not an issue in the hands of competent, unimpaired, and vigilant anesthesia providers.