Limitations of the BIS monitor
The bispectral index (BIS) is a monitor that measures the depth of anesthesia using electroencephalography (EEG); generating a value between 0 (isoelectric EEG, no activity) and 100 (fully awake).
But it’s not perfect:
Doesn’t correlate with end-tidal sevoflurane in children under 12 mo
Inaccurate in children (6 months to 12 years) at high ET sevo, where BIS paradoxically increases as ET sevo increased from 3.0 to 4.0%
Might work in older children
Inaccurate in children with developmental delays (decreases BIS)
Ketamine produces prominent high-frequency oscillations → BIS appears higher than the true depth of anesthesia
BIS does not accurately reflect effects of nitrous oxide (little to no impact of NO on BIS values)
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