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I was always partial to this textbook line…
John Mayers commenting on the disadvantages of the much flouted bispectral index – “I once applied bispectral index electrodes to a serving of cherry gelatin with fruit cocktail from our cafeteria and recorded a bispectral index value of 22

It would be an even bigger problem if it registered 80. That would mean that fruit cocktail had consciousness.
 
But how can they be even partially responsible? Like I get that you're probably right in terms of legal precedent or whatever. But it is completely nonsensical imo. The only person who is responsible is the anesthesia nurse.
Difference between medical direction and supervision, among other things..
 
It's worse than merely random. It reliably drops when paralytics are administered...which is precisely the only time a thoughtful practitioner would want a so-called "depth of anesthesia" monitor.

So, there are only two cases where I refuse to use the BIS:

1) In a non-relaxed patient, because I know the patient can move when he or she gets light. And
2) In a relaxed patient, because though the BIS is generally a terrible "monitor," it is EVEN WORSE when the patient is paralyzed.
I can assure you the BIS would have been higher than 60 on this pt 🙂
 
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