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Personalized Anesthesia

Deliver precision with confidence.

Right dose, better outcomes.1-5

Optimize patient outcomes with personalized anesthesia using noninvasive nociception (pain response) monitoring and brain monitoring.1-9

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Tailor anesthesia delivery with precision for every patient, every time.

Optimizing patient outcomes is at the heart of your practice. A personalized anesthesia approach, combined with real-time insights from depth of anesthesia and nociception monitoring, allows for customized anesthetic delivery based on a patient's physiological characteristics, unique pain levels, and the brain's response to anesthesia.10-14

This tailored approach reduces surgical complications,1-3 and supports faster recovery1,15 with BIS™, while enhances pain management with NOL®.4-6

Personalized anesthesia is here, now.

Every patient is different, and every surgical procedure is unique. 

Traditional anesthesia protocols often overlook individual differences in drug responses, leading to unpredictable or harmful effects .17,18

Excessive administration of anesthetics can result in17,18,30:

  • perioperative neurocognitive disorders,
  • longer emergence times, and
  • extended recovery periods

whereas poor pain management may cause4-6

  • persistent postoperative pain and
  • increased hypotensive events.

By integrating a personalized anesthesia approach with real-time insights from depth of anesthesia and nociception monitoring, you can tailor anesthetic delivery to each patient's unique pain levels and their brain's response to anesthesia.

This precision in care empowers you to concentrate on what truly matters - your patients’ well-being.

Achieve precision in anesthesia with NOL® monitoring technology and BIS™ Advance brain monitor

BIS™ and NOL® working together for optimal patient outcomes1-5

With the NOL – Nociception Level Index® monitoring technology and the BIS™ Advance brain monitor as your partners in personalized anesthesia, you have access to minimally invasive, real-time monitoring of the pain levels and the anesthetic effect on your patient’s brain, empowering you to deliver the right dose for each patient, every time.1-5

With these technologies working in tandem, you can effectively monitor brain activity and nociception levels for each patient, reducing the risk of over- or underdosing1-5. Providing optimal anesthetic dose, personalized to each patient enabled by these technologies, translates to faster recovery times1,15, fewer post-operative complications3 and improved pain management.5

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Personalize anesthesia with BIS™ real-time brain monitoring

The BIS™ Advance brain monitor provides you with valuable insights to optimize anesthetic dosage, ensuring better outcomes for each patient.1,2,19,26,27

Studies show that patients whose anesthetic dosing was guided by BIS™ monitoring technology experienced:

  • faster extubating,
  • faster emergence,
  • better orientation at the PACU, and
  • faster discharge1,15,19

By offering real-time data on the direct and patient-specific effects of anesthesia on the brain, the BIS™ system helps determine and administer the precise amount of anesthetic required19-25. This personalized approach leads to reduced use of anesthetic agents, and improved emergence and recovery times.1,15,19

How does BIS™ monitoring work?

Reliable data based on objective, quantified science is crucial when monitoring the anesthetic effects on a patient's brain. The BIS™ system uses innovative technology to link patientspecific EEG information to an individual's level of consciousness14.

Here is how it works:

  1. Real-time EEG data collection: Sensors collect raw EEG data indicating brain activity in real time.14
  2. Data analysis and filtering: The system uses a clinically validated algorithm to filter, analyze, and correlate the data.14
  3. BIS™ Index Calculation: Results are continually calculated and displayed as the BIS™ index value (a number between 0 and 100), indicating the patient's response to anesthetic agents.14

By customizing individual dosing to keep the BIS™ monitor value within the target range during all phases of anesthesia, clinicians can minimize side effects and postoperative complications, driving faster recovery.1,3,15,19

Personalize your anesthetic care with Density Spectral Array (DSA)

The BIS™ Advance monitor also features Density Spectral Array (DSA) technology, which provides a graphical interpretation of a patient's EEG data, highlighting the spectral features of anesthetic-specific signatures in realtime.

This advanced visualization tool helps anesthesiologists gain deeper insights into a more personalized anesthetic approach.14

Learn more

Features and functionality of the BIS™ Advance brain monitor

The BIS™ Advance monitor comes with a range of features and functionalities, including14: 

  1. EMG (electromyogram) shown in numerical and as a bar
  2. SQI (signal quality index)
  3. BIS™ value (with alarm range if programmed)
  4. SR (suppression ratio) percentage (with alarm limit if programmed)
  5. ST (suppression time) in minutes and seconds
  6. MF (median frequency)
  7. SEF (spectral edge frequency)
  8. Adjustable EEG amplitude scale and sweep speed
  9. Built-in troubleshooting guides
  10. Graphic display of BIS™ value and secondary variable
  11. High-resolution DSA (density spectral array)
  12. Two or four-channel capabilities

Personalized Anesthesia with NOL - Nociception Level Index® technology

The NOL - Nociception Level Index® technology noninvasively quantifies the physiological pain response (nociception) in critical care settings, enabling you to provide a personalized pain treatment according to your patient's anesthetic needs.14

NOL® supports personalized analgesic titration, enabling better control of analgesia and helping to reduce complications and adverse effects of overdosage.4-6

NOL®-guided analgesia has been proven to:

  • Help reduce postoperative pain by 33%5
  • Reduce intraoperative opioids usage by 30%4
  • Reduce intraoperative hypotensive events by 80%4-6
  • Help patients report less severe pain4-6

Learn more

How does nociception monitoring work?
Acquire

The non-invasive platform continuously acquires physiological signals through sensors. Dozens of physiological parameters and derivatives are extracted.13
Analyze

Advanced artificial intelligence algorithms identify the pain-related pattern.13
Quantify

The information is quantified and visualized with the NOL® index on a scale of 0 (no nociceptive response) to 100 (extreme nociceptive response).13
Optimize

NOL® guides clinicians to ensure optimal pain control while avoiding overmedication.4-6,13

Real-world benefits of personalized anesthesia delivered with precision using BIS™ and NOL® technologies
92-year-old patient required pancreatic surgery via laparotomy

The patient was prior to the operation in excellent condition and living on his own.

How can this patient be put under general anesthesia without impacting his health and independence? Prof. Richebé was able to offer precision dosing with confidence.

The patient responded exceptionally well to the anesthetics. The dosages were kept low and adapted to the monitoring values. His opioid and hypnotic consumption were titrated with the help of BIS™ and NOL® monitoring. Also the patients hemodynamics stayed stable throughout the procedure.

His anesthetic agents consumption were kept at a low dose with the help of BIS™ and NOL® monitoring. The patient was quickly extubated in the OR and was even making jokes with the nurses in the PACU, much to everyone’s satisfaction. This is an example of how personalized anesthesia helped this fragile elderly man.

— Dr. Philippe Richebé, MD, PhD, DESAR

Deliver precision, improve efficiency1-5,15

Personalized anesthesia isn't just about patient outcomes; it's an investment in improved hospital efficiency.1,2,4,15

Traditional anesthesia practices can lead to overdosing, causing postoperative complications17, such as POD17 . This results in longer patient stays and higher cost.17,18,28

By embracing personalized anesthesia, you're not only prioritizing patient well-being but also driving cost benefits when it comes to intraoperative pain management.29

Are you ready to join the forefront of modern anesthetic practices?

Explore how NOL® and BIS™ can revolutionize your approach.

Contact us to find out more about these technologies can work in tandem to personalize anesthesia.

Contact us
References

  1. Lewis SR, Pritchard MW, Fawcett LJ, Punjasawadwong Y. Bispectral index for improving intraoperative awareness and early postoperative recovery in adults. Cochrane Database Syst Rev. 2019 Sep 26;9(9):CD003843. doi: 10.1002/14651858.CD003843.pub4. PMID: 31557307; PMCID: PMC6763215. 
  2. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anesthetic delivery and postoperative recovery. Cochrane Database Syst Rev. 2014; (6):CD003843
  3. Punjasawadwong Y, Chau-In W, Laopaiboon M, Punjasawadwong S, Pin-On P. Processed electroencephalogram and evoked potential techniques for amelioration of postoperative delirium and cognitive dysfunction following non-cardiac and non- neurosurgical procedures in adults. Cochrane Database Syst Rev. 2018 May
  4. Meijer, F., Martini, C., Broens, S., Boon, M., Niesters, M., Aarts, L., Olofsen, E., van Velzen, M., Dahan, A. (2019). Nociception-guided versus Standard Care during Remifentanil–Propofol Anesthesia: A Randomized Controlled Trial. Anesthesiology, 130(5), 745-755. doi:10.1097/ALN.0000000000002634
  5. Meijer, F., Honing, M., Roor, T., Toet, S., Calis, P., Olofsen, E., Martini, C., van Velzen, M., Aarts, L., Niesters, M., Boon, M., Dahan, A. (2020). Reduced postoperative pain using Nociception Level-guided fentanyl dosing during sevoflurane anesthesia: a randomised controlled trial. British Journal of Anesthesia, 125(6), 1070-1078 
  6. van der Wal I, Meijer F, Fuica R, Silman Z, Boon M, Martini C, van Velzen M, Dahan A, Niesters M, Gozal Y. Intraoperative use of the machine learning-derived nociception level monitor results in less pain in the first 90 min after surgery. Front Pain Res (Lausanne). 2023 Jan 9;3:1086862. doi: 10.3389/fpain.2022.1086862. PMID: 36700141; PMCID: PMC9869062
  7. Laferrière-Langlois P, Morisson L, Jeffries S, Duclos C, Espitalier F, Richebé P. Depth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050. Anesth Analg. 2024 Feb 1;138(2):295- 307. doi: 10.1213/ANE.0000000000006860. Epub 2024 Jan 12. PMID: 38215709.
  8. Renaud-Roy E, Morisson L, Brulotte V, Idrissi M, Godin N, Fortier LP, Verdonck O, Choinière M, Richebé P. Effect of combined intraoperative use of the Nociception Level (NOL) and bispectral (BIS) indexes on desflurane administration. Anesth Crit Care Pain Med. 2022 Jun;41(3):101081. doi: 10.1016/j.accpm.2022.101081. Epub 2022 Apr 25. PMID: 35472586
  9. Ma D, Ma J, Chen H, Mu D, Kong H, Yu L. Nociception monitors vs. standard practice for titration of opioid administration in general anesthesia: A meta-analysis of randomized controlled trials. Front Med (Lausanne). 2022 Aug 25;9:963185. doi: 10.3389/fmed.2022.963185. PMID: 36091708; PMCID: PMC9454957. 
  10. Berger-Estilita, Joanaa,b,c,∗; Marcolino, Isabeld,∗; Radtke, Finn M.e. Patient-centered precision care in anesthesia – the PC-square (PC)2 approach. Current Opinion in Anesthesiology 37(2):p 163-170, April 2024. | DOI: 10.1097/ACO.0000000000001343 
  11. Meco BC, Jakobsen K, De Robertis E, Buhre W, Alkış N, Kirkegaard PR, Hägi-Pedersen D, Bubser F, Koch S, Evered LA, Saunders SJ, Caterino M, Paolini F, Berger-Estilita J, Radtke FM. A first assessment of the safe brain initiative care bundle for addressing postoperative delirium in the postanesthesia care unit. J Clin Anesth. 2024 Oct;97:111506. doi: 10.1016/j.jclinane.2024.111506. Epub 2024 Jul 6. PMID: 38972091. 
  12. Zeng Shiyue , Qing Qi , Xu Wei , Yu Simeng , Zheng Mingzhi , Tan Hongpei , Peng Junmin , Huang Jing, Personalized anesthesia and precision medicine: a comprehensive review of genetic factors, artificial intelligence, and patient-specific factors, Frontiers in Medicine, Vol. 11, 2024, doi: 10.3389/fmed.2024.1365524, ISSN: 2296-858X
  13.  PMD-200 Pain Monitoring System - User Manual.
  14. BIS Complete Monitoring System - Operators Manual
  15. Quesada N, Júdez D, Martínez Ubieto J, Pascual A, Chacón E, De Pablo F, Mincholé E, Bello S. Bispectral Index Monitoring Reduces the Dosage of Propofol and Adverse Events in Sedation for Endobronchial Ultrasound. Respiration. 2016;92(3):166-75. doi: 10.1159/000448433. Epub 2016 Sep 7. PMID: 27598398
  16. White PF, Ma H, Tang J, Wender RH, Sloninsky A, Kariger R. Does the use of electroencephalographic bispectral index or auditory evoked potential index monitoring facilitate recovery after desflurane anesthesia in the ambulatory setting? Anesthesiology. 2004 Apr;100(4):811-7. doi: 10.1097/00000542-200404000-00010. PMID: 15087615.
  17.  Zhou Y, Li Y, Wang K. Bispectral Index Monitoring During Anesthesia Promotes Early Postoperative Recovery of Cognitive Function and Reduces Acute Delirium in Elderly Patients with Colon Carcinoma: A Prospective Controlled Study using the Attention Network Test. Med Sci Monit. 2018 Oct 31;24:7785-7793. doi: 10.12659/MSM.910124. PMID: 30378591; PMCID: PMC6354643. 
  18. Pérez-Otal B, Aragón-Benedí C, Pascual-Bellosta A, Ortega-Lucea S, Martínez-Ubieto J, Ramírez-Rodríguez JM; Research Group in Anesthesia, Resuscitation, and Perioperative Medicine of Institute for Health Research Aragón (ISS Aragón). Neuromonitoring depth of anesthesia and its association with postoperative delirium. Sci Rep. 2022 Jul 26;12(1):12703. doi: 10.1038/s41598-022-16466-y. PMID: 35882875; PMCID: PMC9325758.
  19. Gan TJ, Glass PS, Windsor A, Payne F, Rosow C, Sebel P, Manberg P. Bispectral index monitoring allows faster emergence and improved recovery from propofol, alfentanil, and nitrous oxide anesthesia. BIS Utility Study Group. Anesthesiology. 1997 Oct;87(4):808-15. doi: 10.1097/00000542-199710000-00014. PMID: 9357882.
  20. Chan MT, Cheng BC, Lee TM, Gin T; CODA Trial Group. BIS-guided anesthesia decreases postoperative delirium and cognitive decline. J Neurosurg Anesthesiol. 2013 Jan;25(1):33-42. doi: 10.1097/ANA.0b013e3182712fba. PMID: 23027226
  21. .Glass PS, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers. Anesthesiology. 1997 Apr;86(4):836-47. doi: 10.1097/00000542-199704000-00014. PMID: 9105228. 
  22. Alkire MT. Quantitative EEG correlations with brain glucose metabolic rate during anesthesia in volunteers. Anesthesiology. 1998 Aug;89(2):323-33. doi: 10.1097/00000542-199808000-00007. PMID: 9710389
  23. McCann ME, Bacsik J, Davidson A, Auble S, Sullivan L, Laussen P. The correlation of bispectral index with endtidal sevoflurane concentration and haemodynamic parameters in preschoolers. Paediatr Anesth. 2002 Jul;12(6):519-25. doi: 10.1046/j.1460-9592.2002.00886.x. PMID: 12139593. 
  24. Whyte SD, Booker PD. Bispectral index during isoflurane anesthesia in pediatric patients. Anesth Analg. 2004 Jun;98(6):1644-1649. doi: 10.1213/01.ANE.0000117223.84646.36. PMID: 15155318.
  25. Degoute CS, Macabeo C, Dubreuil C, Duclaux R, Banssillon V. EEG bispectral index and hypnotic component of anesthesia induced by sevoflurane: comparison between children and adults. Br J Anesth. 2001 Feb;86(2):209-12. doi: 10.1093/bja/86.2.209. PMID: 11573661.
  26. .Luginbühl M, Wüthrich S, Petersen-Felix S, Zbinden AM, Schnider TW. Different benefit of bispectal index (BIS) in desflurane and propofol anesthesia. Acta Anesthesiol Scand. 2003 Feb;47(2):165-73. doi: 10.1034/j.1399-6576.2003.00041.x. PMID: 12631045.
  27. Song D, Joshi GP, White PF. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia. Anesthesiology. 1997 Oct;87(4):842-8. doi: 10.1097/00000542- 199710000-00018. PMID: 9357886. 
  28. Weinrebe W, Johannsdottir E, Karaman M, Füsgen I. What does delirium cost? An economic evaluation of hyperactive delirium. Z Gerontol Geriat. 2016;49:52–58. doi 10.1007/s00391-015-0871-6
  29. Saunders R., Weissbrod R. (2020). Cost benefit of personalizing intraoperative pain management. Presented at ISPOR Virtual Conference, May 2020
  30. Evered L, Silbert B, Knopman DS, et al; Nomenclature Consensus Working Group. Recommendations for the nomenclature of cognitive change associated with anaes- thesia and surgery-2018. Br J Anaesth. 2018;121:1005–1012

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