Bispectral Index Monitoring – for Your Safe Anaesthesia

The purpose of overall anaesthesia is to put the patient to artificial sleep and thus, to prevent unpleasant perception of pain caused by surgery. Up-to-date anaesthetic medicaments influencing brain activity are used for this, while the required anaesthesia depth is achieved by correct dosing. For monitoring and evaluation of overall anaesthesia depth and its quality, we use also monitoring of blood pressure, pulse frequency, relaxation quality, blood oxygen saturation and ventilation values besides the check of the clinical status of the patient. The experienced anaesthesiologist decides from these parameters, whether anaesthesia is so that the patient is in optimum stabilised status with respect of the surgery type.

Recently, the above mentioned ways of patient monitoring have been extended by a new method of monitoring overall anaesthesia quality, the so called bispectral index monitoring (BIS). This method consists in continuous scanning of electrical brain activity during surgery, signal processing and graphic and numerical evaluation on the BIS monitor screen. This non-invasive monitoring starts by sticking a special patch strip with electrodes on the patient’s forehead and connecting it with the monitor itself – without any punctures. It is very similar to monitoring electric activity of the heart (EKG) with the difference that BIS monitoring concerns electric activity of the brain, which changes in dependence on patient’s consciousness status. It is different in a completely conscious person compared to a person falling asleep, being medicated into artificial sleep or getting up from overall anaesthesia. Plastic surgery similar to other surgical disciplines cannot exist without anaesthesia or desensitization. For the surgeon to be able to perform a surgery, it is necessary to secure painlessness of the surgery and the patient’s comfort during and after it. In principle, this can be achieved either by local anaesthesia of the treated area or by putting the patient to sleep (by overall anaesthesia).

Local anaesthesia results in absence of pain in the area subject to surgery at full consciousness of the patient during surgery. It is mostly used in operations of smaller extent and anaesthesia is applied by the surgeon by an injection in the treated area.

“Now it will bite a little bit and then you will not feel anything more”. This is the information heard by the patient from the surgeon at the operating room. Really, you will not feel anything during surgery and after its end the local anaesthesia injection continues to be effective for some time. Thus, the patient can leave for home almost immediately after surgery end. Perfect comfort during surgery with local anaesthesia can be even enhanced by administration of medicaments influencing the overall status of the patient. They decrease the patients’ fear of the surgery, restrain pain in a complex way and result in a status of fatigue and the need of closing one’s eyes and having a nap. This combination with local anaesthesia is called analgosedation. Its administration in our Clinic already belongs into the hands of an anaesthesiologist. This type of anaesthesia is very pleasant, but it requires a longer stay at the clinic and a person for accompanying the patient home as the effect intravenously applied medicaments fades out only slowly. It is ideal for those who do not want to see, to hear and to feel anything, are not in a hurry and fear overall anaesthesia (narcosis). Analgosedation can be used only in selected surgeries of smaller extent where the patient’s stay at the bed department of the Clinic is not necessary. As a surgeon, I appreciate top technology used for anaesthesia in the LAUREA clinic. On the BIS monitor screen I can see that the patient is exactly in the narcosis depth necessary for the surgery being performed.” says Dr. Josef Hrbatý. Surgical interventions of bigger extent, with the necessity of a stay at the Clinic, are performed in overall anaesthesia (narcosis). It is an artificially introduced status, during which the patient is in artificial unconsciousness, feeling no pain and with muscles relaxed. The patient gets intravenously medicaments with pronounced, immediate effect and falls asleep within a few seconds. These medicaments “switch off” consciousness, interception of pain, but also breathing (an apparatus breathes for the operated patient). Their administration belongs into the hands of an experienced physician – an anaesthesiologist carefully following basic life functions of the patient, his/her consciousness status and/or depth of artificial unconsciousness, parameters of artificial ventilation and the bloodstream status during the surgery itself. One can say without exaggeration that the life of the patient is in the hands of the anaesthesiologist during surgery. The anaesthesiologist has, besides knowledge and experience, the monitoring devices showing graphically all vital functions of the sleeping patient’s body in order to maintain the patient in a stabilised status with sufficiently deep narcosis. Thus, the anaesthesiologist can react immediately in case of any deviations. This is the reason why it is not necessary to fear overall anaesthesia any more. Thanks to up-to-date anaesthesiologic devices, perfect monitoring technique, advanced medicaments (anaesthetica) with minimum side effects, overall anaesthesia is very safe at present. We in our Clinic focus very carefully on providing our patients with the best of what the present medicine can offer. To gather all necessary data on the patient’s health status for the anaesthesiologist, the patient must pass the pre-surgery examination. Its aim is to detect his/her overall health status and/or find hidden problems that could influence anaesthesia course and the surgery result. Thus, all our patients pass such an examination before surgery as well as a detailed interview with the anaesthesiologist before surgery. Sense of such thorough prevention is unequivocal. In this way, we exclude anything that could adversely influence smooth narcosis course. Only if this thorough pre-anaesthesia examination has satisfactory results, the patient gets an injection for overall calming and inner stabilisation (pre-medication) and leaves for the operation room. After surgery end, the patient wakes up in the operation room within a few minutes. As soon as his/her status is stabilised and signs of overall anaesthesia fade out, he/she leaves for the bed department of the Clinic where all his vital functions continue to be monitored in the same way as during surgery and medicaments mitigating pain, if any, are administered. Dr. Radoslav Hujňák: „BIS Monitoring means safety, quality and certainty for the patient.“ Anaesthesia at the LAUREA Clinic is a team work of experienced physicians and erudited nurses. Our aim is top quality of our work, as the life of the patient is in our hands. We cannot allow anything below absolute top quality.

Frequently Asked Questions

… Is it necessary to pas the pre-surgery examination before overall anaesthesia? Yes, it is. The patient gets medicaments (anaesthetica) during overall anaesthesia that influence all the functions of his/her body. The pre-surgery examination aims at detecting all disorders that – combined with overall anaesthesia – could expose the patient to failure of vital organs. It is a thorough check of your body before you lie down on the operating table. … Why am I not allowed to eat and drink before surgery in overall anaesthesia? Overall anaesthesia puts out defence reflexes of the patient’s body. The stomach content (fluids and food) could return to the oral cavity and be inhaled into the lungs. Here they would cause a serious damage to the ventilation functions. Thus, it is necessary to observe the safety interval between last meal and start of overall anaesthesia. Usually I recommend a light supper with sufficient liquids and complete abstinence from eating and drinking starting with midnight. … I am afraid that I will not fall asleep, recently I have problems to fall asleep and I repeatedly wake up at night.

Your fear is unsubstantiated. For overall anaesthesia, we use anaesthetica that put every patient to sleep within a few seconds. To the contrary of your domestic natural sleep that can be influenced by a series of spurious factors, the artificial sleep (overall anaesthesia) is deep and continuous and is influenced only by the type and amount of administered anaesthetica.

… I always feel thick after anaesthesia and suffer of vomiting. Will this repeat again? Vomiting after anaesthesia occurs in a small percentage of our patients. The exact reason has not been unequivocally determined yet. It can occur, even if you carefully observe the pre-surgery prohibition of eating and drinking. Partly it can be influenced by the neuro-vegetative instability of the patient, by the scope and place of surgery, by administered anaesthetica and by other factors. Partly it can be influenced by medicaments limiting the occurrence of nausea and vomiting in relation to overall anaesthesia. Thus, it is necessary to inform the anaesthesiologist about this problem in the anaesthesiological interview in the morning before surgery. … Can it happen that I wake up during surgery? No, it cannot. The depth of the artificial sleep is determined in relation to nature and scope of surgery. It is carefully followed by the anaesthesiologist during surgery and overall anaesthesia and all vital functions of the body are monitored and shown on screens. We use up-to-date, reliable dosing devices in our operation room to secure continuous dosing of anaesthetica to the patient’s organism in order to achieve the necessary anaesthesia depth during all the surgery. … Will I get an injection to the vein or will I have to breathe in something? We use intravenous administration in our clinic. After arrival at the operation room, the anaesthesiological nurse shall inject a cannula to the vein in the arm of the patient and shall connect an infusion solution to it. The cannula application is the only pain that the patient has to undergo. Afterwards, the patient gets medicaments introducing artificial sleep (anaesthetica) already without pain through this cannula. The cannula with the infusion remains applied usually to the next day. … How long after surgery will I wake up?

Vital functions influenced (put out of operation) by overall anaesthesia will restore within a few minutes after surgery end.

First, ventilation and defence reflexes are restored and after a few minutes, consciousness returns. After a while, the patient is able to open his/her eyes, to breathe in deeply and/or to grasp his hand when asked to do so. This is the normal course of fading anaesthesia. The patient is able to follow these instructions already a few minutes after the last stitch in his/her operation wound. Restoration of full consciousness and the usual communication comfort is then influenced usually by the length and scope of surgery and takes several hours, before the body metabolises and eliminates last remainders of the anaesthetica. … Will I have the ventilation tube in my throat during narcosis? Yes, you will. This tube (intubation cannula) is necessary for artificial ventilation during narcosis when the patient does not breathe, but an apparatus (ventilator) breathes for him/her. The cannula is introduced to the patient’s throat after his/her falling asleep and is removed after narcosis end. The patient is not aware of it at all and has no unpleasant memories.
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