BIS Monitoring Limitations for Intubation Response Assessment

Introduction to BIS Monitoring

BIS is best suited for sedative titration during deep sedation or neuromuscular blockade when clinical assessment is impossible, as recommended by the American Society of Anesthesiologists 1

BIS monitoring appears most reliable with propofol-based anesthesia, showing good correlation with sedation depth, according to the American Academy of Pediatrics 2, 3
BIS values paradoxically increase with ketamine and sevoflurane despite adequate anesthesia depth due to central excitation, as noted by the American Society of Anesthesiologists 2, 3
Opioids and benzodiazepines have minimal and variable effects on BIS, yet these agents are crucial for blunting intubation response, as stated by the American College of Clinical Pharmacology 2, 3
BIS cannot distinguish between deep sedation and general anesthesia, nor can it predict hemodynamic or motor responses to stimulation, according to the Society of Critical Care Medicine 2