Is there a consensus concerning the routine use of BIS monitoring during general anesthesia?

My personal opinion is as follows: Aspect Medical and some patient advocate groups appear to have “pushed” hard for the adoption of BIS or other brain activity monitor as a standard of care for routine intraoperative monitoring of general anesthesia.  The lack of information about the algorithms used to derive the BIS index and other proprietary indexes, the lack of understanding of the factors that lead to awareness under anesthesia, the fact that many operations do not lend themselves to intraoperative brain activity monitoring, and the several published counter-examples in which information provided by the BIS monitor seems to contradict the claims for the product make many thoughtful investigators and practitioners uncomfortable with the concept that this monitor or monitors of this type should be enshrined as “standard.”  The fact that these monitors do not rise to the level of a standard however does not mean that they are not useful.  Nor does it mean that they should not be used.  The decision of the American Society of Anesthesiologists committee on practice parameters to not endorse brain activity monitoring routinely should not be construed as a lack of interest on the part of anesthesiologists in the problem of intra operative awareness (see ASA guidelines on intraoperative awareness, http://www.asahq.org/publicationsAndServices/AwareAdvisoryFinalOct05.pdf ).

David S. Smith, M.D., Ph.D.