For our geriatric cases, I’m leaning on BIS/SedLine more to target lighter volatile and avoid oversedation, but it’s inconsistent across rooms and staff… Has anyone standardized on one processed EEG monitor, and did it move the needle on hypotension or delirium rates? I’m seeing fewer swings with BIS around 40–55 in about 30 hips last month, and I’m curious what alarm limits and documentation protocols others find safest.
We standardized on BIS for geriatric hips and set alarms 35–65 with a simple rule: ‘BIS <40 for >3 min = lower volatile about 0.2 MAC and keep MAP >65,’ which cut the pressor whack-a-mole. Caveat: verify raw EEG/EMG before chasing numbers, and if BIS >60 but hemodynamics are fine we treat analgesia first. Are you pairing a MAP floor with your BIS alarms, and is your upper limit 60 or 65?
Quick example: we kept BIS but made the ‘alarm’ the suppression ratio — SR >5% sustained >2 min triggers a small MAC step-down and a reminder to keep MAP >=65. ENGAGES didn’t show a delirium drop with EEG guidance, but it cut burst suppression, so we track ‘minutes SR>0 with MAP<65’ monthly to nudge practice (https://jamanetwork.com/journals/jama/article-abstract/2733515). It’s like cruise control — you still watch the road.
I find maintaining a BIS around 40–50 really helps with sedation levels. Have you noticed any improvement in recovery times since starting with 30 hips?