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Should you use a brain monitor?
So what's the answer to avoiding patient awareness under anesthesia?
Not necessarily brain monitors, says Richard J. Pollard, MD, chief of neuroanesthesia at Southeast Anesthesiology Consultants in Charlotte, NC.
"We have very low incidence of recall, and we don't use brain monitors of any variety," he says. Pollard's research indicated an incidence rate of 0.0068%.1
Others see benefits in the monitors. Michael Rieker, DNP, CRNA, director of the Nurse Anesthesia Program at Wake Forest University Baptist Medical Center in Winston-Salem, NC, says, "Smaller same-day surgery centers may defer purchase of anesthetic agent monitors due to budgetary constraints, but these monitors can be a very useful tool in ensuring that the patient is receiving the intended amount of anesthetic." However, even Rieker warns that you shouldn't put your trust completely in such monitors. "Unfortunately, there are many false-positives and false-negatives in the readings provided by the monitors we have," he says. "If an awareness monitor can fool you on even one patient, then you cannot put your total trust in it on any patient. " Instead, these monitors provide a bit of additional information that should be used to augment, verify, or dispute what the practitioner already has determined, he maintains. "Without the required degree of vigilance, insight, and clinical assessment acumen, awareness can occur with or without an electronic monitor," Rieker says.
Others who support the monitors include Donald M. Mathews, MD, associate chairman for academic affairs at the Department of Anesthesiology, St. Vincent's Hospital Manhattan (NY) and assistant professor of clinical anesthesiology at New York Medical College in Valhalla. "I personally use the monitors in all my patients who receive general anesthesia because I believe the information that I obtain allows me to make better decisions as I care for my patients," Mathews says. "A secondary benefit, and not the primary reason I use these monitors, is that I hope to decrease the chance of one of my patients experiencing awareness."