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Exploring the Future of Patient Safety: Is BIS Monitoring the Key to Improved Sedation Practices?

By: Dr. Travis Coulter

Published: 4/2/2024

We all know that technology plays a pivotal role in enhancing patient care and safety. The key question is whether a tech item is truly useful or just a fun gadget. A prime example of this technological advancement is the utilization of Bispectral Index (BIS) monitoring. Xchart does not currently have the capability to automatically capture and report BIS monitoring data, but we are intrigued. Besides sharing with each of you things that are cutting edge, we also are interested in discovering the need that exists for us to incorporate BIS monitoring into the Xchart platform.

BIS monitoring, essentially, is a sophisticated method that quantifies a patient's level of consciousness during sedation. This technology utilizes electroencephalography (EEG) data to generate a score ranging from 0 (no brain activity) to 100 (fully awake), providing healthcare providers with real-time insights into the patient's sedation depth. This revolutionary tool ensures that patients are not under or over-sedated, a balance critical for patient safety and comfort.

To achieve BIS monitoring, the setup involves acquiring specific equipment. Essential components include a BIS monitor, capable of translating EEG data into an understandable BIS score, and associated sensors that are placed on the patient's forehead to collect brainwave information. Providers can choose between a 2-channel, which offers basic Bispectral Index (BIS), Signal Quality Index (SQI), Electromyography (EMG), Suppression Ratio (SR), and Electroencephalogram (EEG) parameters, while the 4-channel system provides additional capabilities of features like Total Power (TP) and Spectral Edge Frequency (SEF) for a more comprehensive analysis. Each system requires disposable sensors, with options available for pediatric patients.

In the domain of dentistry, BIS monitoring has been increasingly adopted for procedures requiring sedation. Studies highlight its utility in enhancing patient safety during dental treatments, including third molar extractions and other surgeries where precise sedation management is crucial. By employing BIS monitoring, dental professionals can adjust sedation levels in real-time, ensuring optimal patient comfort while minimizing the risk of complications associated with over-sedation.

Moreover, the implementation of BIS monitoring extends beyond dentistry, having a profound impact on pediatric care, plastic surgery, and even the standardization of sedation practices as seen in Germany's national guidelines. These applications underscore the versatility and value of BIS monitoring in providing tailored care and enhancing patient outcomes across various medical fields.

For sedation providers, the benefits of BIS monitoring are manifold. It not only enables the precise administration of sedatives, leading to improved procedural efficiency and patient satisfaction but also significantly reduces the potential for sedation-related adverse events. BIS monitoring supply companies report the need for fewer anesthetic agents used, faster wake-up times, and decreased occurrence of delirium when BIS systems are fully utilized. For patients, this means safer procedures, faster recovery times, and a more comfortable experience during and after sedation.

Of course, we all go to the same question: how much does this cost? The two most popular BIS systems currently are from Medtronic and Philips. We were able to get cost estimates from $5,000 to $15,000 for initial purchase, setup, and training. It does need to be noted that, similar to ECG pads, each patient will use disposable BIS monitor stickers with pediatric-specific ones.

So, is BIS monitoring the key to improved sedation practices? In short, it shows promising results as a useful tool, but nothing can replace a well-educated and skilled provider with a solid team backing them up. However, BIS monitoring represents a paradigm shift in how patient care is administered in both dentistry and medicine. By offering a nuanced understanding of a patient's sedative state, BIS monitoring has the potential to empower sedation/anesthesia professionals to provide safer, more effective care. Like anything else, it does require more equipment with more leads that can be cumbersome for treatment. As technology continues to advance, its integration into healthcare practices promises to further revolutionize patient outcomes, making procedures safer and more comfortable for patients and, over time, should become more cost feasible and possibly become a standard of care.

Are you a provider currently utilizing BIS monitoring? We would love to hear from all of you regarding all positives and negatives associated with your BIS monitoring system. Continue the conversation by emailing me at

Stay paperless,

Dr. Travis Coulter

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