Article Notes
This paper is full of many important pearls, and should be read in full.
Regarding common practices in the conduct of BIS-guided anaesthesia:
It has been suggested that a BIS range of 60–75 is suitable for ‘the end of surgery’, but our results show that if neuromuscular block is used, this range is consistent with full awareness.
...and on the use of the Signal Quality Index:
Given that the major cause of patient-related artifact is movement, it is not surprising that the SQI will increase towards 100 when NMBDs are administered, as we found. Unfortunately, the high SQI will indicate that the BIS is at its most reliable exactly when it is performing most poorly in the aware but paralysed patient.
There is some evidence supporting the benefit of perioperative intravenous lignocaine/lidocaine infusion in both laparoscopic and open abdominal surgery.
The strongest evidence supports both improved analgesia and reduction in nausea, with weaker evidence suggesting faster improvement in GIT function and earlier discharge from hospital.
Safety data is reassuring but far from conclusive due to the small size of most studies.