Toward solving the sedation-assessment conundrum: Bispectral index monitoring and sedation interruption

The sedation-assessment conundrum arises from the conflict between two opposing goals: to maintain a safe and comfortable environment for the patient through the use of sedation, and the need for accurate neurologic evaluation that reflects the patient's best possible effort. Planned interruption of continuous intravenous sedation is a necessary part of routine nursing practice in the neuroscience critical care unit. The use of BIS monitoring as an adjunctive tool for sedation assessment to facilitate planned interruption in sedation is helpful in achieving a valid neurologic assessment. Critical care nurses are highly proficient at integrating specialized knowledge, skills, and technology into practice. Sandelowski [84] writes, "As the primary machine tenders in health care, nurses often acquire an understanding of how to apply, operate, and interpret the products of devices that becomes an integral part of the tacit know-how of clinical practice." Knowing how and when to place faith in technology, and to find the balance between objective and subjective assessment, allows for solutions to the sedation-neurologic assessment conundrum.