BIS Monitoring Transformed Opioid-Free Propofol Ketamine Anesthesia From Art to Science for Ambulatory Cosmetic Surgery.

Measurement is the essence of science. The BIS™ brain monitor provides direct propofol response measurement. Measuring transformed the propofol ketamine technique from a qualitative approach to a quantitatively reproducible one. Propofol was originally titrated with an IV bag and a micro-drip IV set. Propofol response was titrated to clinical signs. An infusion pump later replaced the IV bag, enabling the propofol dose enumeration. The propofol effect was measured with a BIS.™ A statistically significant 30% propofol reduction was achieved with BIS™ monitoring. Patient movement occurred during propofol sedation. Secondary EMG trending to BIS™ enabled the differentiation of cortically based movement (i.e., deeper sedation indicated) from spinal cord-based movement (i.e., more local indicated). Outcomes were improved when surgeons re-injected vasoconstricted field with patient movement. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .