Monitoring depth of anaesthesia: is it worth the effort?

In this review paper, the authors critically analyse the use of a number of depth of anaesthesia monitors in light of the most recent literature and their own clinical experience. There appears to be increasing evidence that anaesthesia depth monitors reduce the incidence of unexpected intraoperative awareness and also that they improve the quality of anaesthesia. Proper use of these monitors necessitates background knowledge about the physiology of the loss of consciousness, the type of variable recorded and processed by the monitoring devices, the factors that might interfere with recording and the limits of use. The information provided by anaesthesia depth monitors is detailed and relationships with clinical practice are established to provide the reader with key features for optimal use of those monitors and correct interpretation of data. Practitioners and patient's knowledge and expectations regarding this matter, as well as the cost-benefit relationship are also discussed.