While most anesthesiologists agree that awareness under anesthesia is a possibility and a potential problem, most do not agree that the incidence of the problem is as frequent as noted by the study, which was financed by the company. Proponents of the monitor argue that the widespread belief that the incidence is very low is only due to unwillingness in the profession to ask the right questions and follow patients closely after their anesthetics. Other anesthesiologists concede that awareness may be more prevalent than previously believed, but question whether the solution is an additional monitor that may or may not give essential information.

Clearly, the results that have been released by the company and widely reported in the media should be taken with a grain of salt. In addition to the fact that the study was financed by the company, it should be noted that the study results have not yet been published in a peer-reviewed journal. The American Society of Anesthesiologists (ASA) has released a statement regarding the issue that notes in part, "At question here is the issue of whether the use of a device that monitors merged electroencephalography (EEG) signals is useful in decreasing the incidence of patient awareness while undergoing a general anesthetic."

This site has previously published information about the BIS monitor and has gone on record as stating that this technology clearly can offer information that is important to the anesthesiologist during a case, awareness monitoring is a useful tool for teaching about the concepts related to balanced anesthesia and awareness monitoring can be useful in the performance of total intravenous anesthesia (TIVA), especially with Propofol. However, it is clear that this issue must be addressed with peer-reviewed scientific data instead of articles in the popular media that may or may not distort the truth and can cause unnecessary worry in patients undergoing anesthesia. It is a disservice to both patients and anesthesiologists to treat this issue differently than other scientific questions that must be studied and proven.

Until all the data is in, it certainly does not hurt to use these monitors in the right circumstances. However, to state at this point in time that these monitors are mandatory or worth the extra cost associated with them is still not completely valid. Information about our patients' state of consciousness may be something that we want to know, but whether it is essential to our practice remains to be seen.