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Anesthesia

A More Complete Picture of the Brain's Response to Anesthesia

Brain function monitoring delivers clear, objective, real-time insight into a patient's depth of anesthesia and sedation. To facilitate faster assessment of patient status, the SEDLine monitor provides the Patient State Index (PSI™), a calculated measure of brain activity that reflects the patient's current level of sedation/anesthesia1. Visit the Technology section to learn more about how the PSI is calculated.

The goal of anesthesia during a surgical procedure—for an event-free case—is to administer a balance of drugs that achieve appropriate levels of:

  • > Areflexia (absence of movement)
  • > Analgesia (absence of pain)
  • > Loss of consciousness (sedation/hypnosis)
Anesthesia diagram

When used as an adjunct to traditional monitoring, brain function monitoring enables the anesthesia provider to deliver the desired level of targeted sedation throughout all phases of anesthesia to:

  • > Optimize anesthetic depth
  • > Enhance patient care

Geriatric patients

  • > Variable response to anesthetics
  • > Minimum alveolar concentration (MAC) of inhalation agents decreases with age
    • • For every 10-year age increase, 6% decrease in MAC
  • > Increased sensitivity to opioids
    • • More susceptible to overdose and slow recovery in post-anesthesia care unit (PACU)
    • • Changes in hemodynamics have little to do with anesthetic depth; a more accurate reflection of patient's baseline physiological status
  • > Brain function monitors help titrate anesthetic to keep patient in optimum range
    • • Allows anesthesiologists to control changes in BP with vasoactive drugs rather than extra anesthetic
    • • Facilitates reduced use of anesthetics which may influence POCD (Post operative cognitive dysfunction
  • > Brain function monitoring enables fast extubation
Dr. Terri Monk "I have found that as I have used depth of anesthesia monitoring in the operating room that the majority of the changes in hemodynamics that occur in the elderly patient during the surgical procedures have very little to do with the amount of anesthesia they are getting."

Terri Monk, MD
Professor
Department of Anesthesiology
Duke University Medical Center
Durham, NC

Dr. David Drover "SEDLine gives me a better idea of where I stand at each phase of anesthesia. The brain number helps guide me to make subtle changes in my anesthetic appropriate for the patient's heart rate and blood pressure, and thus arrive at the end where I want to be."

David Drover, MD
Associate Professor of Anesthesia
Stanford University Hospital
Stanford, CA

Morbidly obese patients

  • > Difficult to intubate and secure patient's airway
  • > Drugs distributed differently
    • • Fat layers store anesthesia and can result in over- or under-anesthetizing patient
  • > Postoperatively, patients recover differently from anesthesia
  • > Brain function monitors should be used throughout anesthetic process to help better judge amount of induction agent
  • > During maintenance phase, brain function monitoring facilitates individualized titration and can minimize amount of anesthesia administered
Dr. Martin Allard "Adequate monitoring and the use of SEDLine and cerebral function monitoring, I believe, is important in these patients. It should be started before we begin the anesthetic and then utilized throughout the time that one does so."

Martin Allard, MD
Professor of Anesthesiology
Dir. of Anesthesia Research
Loma Linda University
Medical Center
Loma Linda, CA

Ventilated ICU patients

  • > Still struggling to properly sedate ventilated patients in the ICU
  • > Most patients are over-sedated, resulting in increased time spent on ventilation with a prolonged stay in the ICU and increased costs
  • > Goal is to more tightly control sedation to avoid these negative outcomes
  • > Brain function monitoring is a functional tool in the ICU that may help to reduce:
    • • Costs
    • • Morbidity
    • • Length of stay in the ICU
Dr. Michael Ramsay "We need much better monitors of the brain and to use these monitors of the brain. I think this is the advantage that SEDLine brings to you is that it doesn't just look at one little area of the brain. It looks at both sides of the brain."

Michael Ramsay, MD
Chairman
Dept. of Anesthesiology
Baylor University Medical
Center
Dallas, TX

ICU Sedation

Accurately assessing level of sedation in ICU patients has been a challenge. The effectiveness of using physiologic measures such as vital signs or response to stimulation is compromised by the presence of other drugs. Monitoring sedation through the use of sedation assessment scales is limited to single point measures in time. Further, the accuracy of sedation assessment scales may be compromised by subjectivity and inter-rater variability.

Correlation Between PSI and Ramsay Sedation Scale (RSS)

A strong correlation between the PSI values and the Ramsay Sedation Scale (RSS) as demonstrated in a recent study2 provides the opportunity to effectively manage sedation and analgesia in an objective, consistent manner across the continuum of care, especially in intubated, ventilated ICU patients. Further, changes in the PSI in response to clinical events provide an early warning for patient safety as highlighted in a recent review of sedation measures in the ICU3.

By enabling a more accurate assessment of a patient's level of sedation, SEDLine helps the clinician to maintain sedation levels within the target range.

This may help add value to patient care by contributing to:

  • • Improved patient safety
  • • Optimized medication levels
  • • Reduced ventilator days
  • • Reduced cost
graph showing PSI vs RSS

"As this technology gets better, as we have with the SEDLine - easy to apply, fewer artifacts - this now becomes a functional tool to correctly control our sedation levels and reduce costs in our ICU, reduce morbidity in our ICUs and reduce stay in our ICUs."

Michael Ramsay, MD, Chairman, Department of Anesthesiology
Baylor University Medical Center, Dallas, TX

  • 1 Prichep LS, Gugino LD, John ER, et al. The Patient State Index as an indicator of the level of hypnosis under general anesthesia. Br J Anaesth. 2004,92:393-399. Available online at http://bja.oxfordjournals.org/cgi/content/full/92/3/393.
  • 2 Schneider G, Heglmeier S, Schneider J, et al. Patient State Index (PSI) measures depth of sedation in intensive care patients. Intensive Care Med. 2004,30:213-216. Abstract available online at http://www.ncbi.nlm.nih.gov/pubmed/14673519.
  • 3 Sessler CN, Grap MJ and Ramsay AE. Evaluating and monitoring analgesia and sedation in the intensive care unit. Critical Care 2008, 12(Suppl3):S2. Available online at http://ccforum.com/content/12/S3/S2.

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