NICE has assessed 3 electroencephalography (EEG)-based depth of anaesthesia monitors - Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M - to help the NHS decide whether to use these products.

These monitors are used alongside clinical monitoring to assess a patient's response to anaesthetic drugs during surgery. The aim is to help the anaesthetist tailor the dose of anaesthetic used to the individual patient. This is important because too little anaesthetic can mean a patient is aware of what is happening during surgery. On the other hand, too much anaesthetic can result in a patient taking longer to recover from surgery.

NICE has said that the BIS monitor is an option during any type of surgery in patients at higher risk of awareness during surgery or at higher risk of excessively deep anaesthesia, and in all patients receiving total intravenous anaesthesia. There is more uncertainty about the clinical benefits of the E-Entropy and Narcotrend-Compact M monitors than the BIS monitor. But NICE has said that the monitors are all broadly equivalent, so E-Entropy and Narcotrend-compact M monitors are also recommended as options.

NICE is aware that the Association of Anaesthetists of Great Britain and Ireland (AAGBI) has updated its recommendations for standards of monitoring during anaesthesia and recovery since the publication of diagnostics guidance 6. The standards include recommendations on the use of depth of anaesthesia monitors and can be found at the AAGBI website.


Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)