BPH ENERGY LTD — Investor Presentation 2018

Nov 25, 2018

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23 11 2018

The Manager Market Announcements Office Australian Securities Exchange Exchange Centre 20 Bridge Street SYDNEY NSW 2000

Successful Trials of Cortical BARM Monitor at Strathfield & St. Luke’s Hospitals -Sydney

BPH Energy Ltd (BPH) is extremely pleased to provide detail on further successful trials of the Cortical BAR Monitor (BARM) at St. Luke’s Private Hospital and Strathfield Private Hospital in Sydney. Strathfield is part of the Ramsay hospital Group.

The trials have been conducted by Dr Adrian Sultana MD FRCP (Glasg) FANZCA, a consultant anaesthetist. He is appointed as a Conjoint Lecturer at the Prince of Wales Clinical School, University of New South Wales and is also a Clinical Lecturer in Anaesthesia at the Australian School of Advanced Medicine, Macquarie University. He is also a director of the International Society for the Perioperative Care of the Obese Patient.

Key conclusions from these trials by Dr Sultana trialling BARM during 2018 include

• The BARM has shown “ significant reduction in anaesthesia recovery time using TIVA . (Total intravenous anesthesia is a technique of general anesthesia which uses a combination of agents given exclusively by the intravenous route without the use of inhalation agents (Gas Anesthesia)) with the BARM”.

• The Cortical BARM was “ Remarkably stable and the responsive signal permitted a new level of belief in the awareness monitoring technique and allowed him to run cases at a CCS index of 45 with confidence in early tapering of the patients anaesthesia using TCI (infusions of propofol and remifentanil)

• The BARM had impressive stability and speed of response. He reported that “ he was able to administer significantly less TIVA and was able to have the patient wake within 3 minutes of the end of the operation.

• Dr Sultana reported that “Often when using the BIS/Entropy(monitors), they dramatically lag the patents emergence and he has had patients that take up to 20 minutes to wake up. Note he reported the patients emerged at CCS index of 70

• In usage with NMB (Neuromuscular Block) he was able to “achieve accuracy, predictability and a smooth wake up”

• The BAR Monitor has now been used with 109 patients at Strathfield and St Luke’s Hospitals

Cortical believes these conclusions have significant implications for hospital operations

• Optimising the dose of anaesthetic agent used can reduce the use of anaesthetic agents, and improve patient turn-around times and lead to cost savings

• Facilitate the delivery of higher quality and more reliable service to hospitals and patients

BPH Energy Limited ACN 095 912 002 PO Box 317, North Perth, Western Australia 6906 14 View Street, North Perth, Western Australia 6006 admin@bphenergy.com.au www.bphenergy.com.au

Operating theatre (OT) services represents a significant proportion of hospital costs, but also are the largest source of revenue-Anaesthesia is a key part of this solution.

• The operating room accounts for 40% of total hospital expenses, and it generates 70% of the revenue (2)

• Operating theatres’ cost constitutes a huge investment of healthcare resources, approximating one-third of total hospital budget. Thus, there is an increasing interest in providing an “efficient” anaesthetic and surgical service, to make operations the largest potential source of income (3)

• Regardless of the length of the session, useful OT (Operating Theatre) efficiency measures include: • OT utilisation • anaesthetic care time (1)

• An overall reflection of how efficiently OTs are utilised can be determined by the operating theatre utilisation rate together with anaesthetic care time. (1)

• In rank order, the costs of surgery come from (highest to lowest) (a)hospital charges -most expensive charges (b)use of OR Room=Thus quicker out means lower costs

• Greater cost savings may come with improving operating room efficiency as well as those processes of care that reduce length of hospital stay (while maintaining similar or improved quality of care). This would seem more important than restriction of anaesthesia agents, supplies, and equipment. (4)

• Thus, if anaesthesia expenses would be increased in order to get the patients out of the operating room faster, then it would not matter much for the overall calculations and it would in the end be possible to run an extra case in that operating room. (5)

The Cortical BARM meets the three main hospital purchase requirements

• Technology benefits – should be useful for clinicians

• Clinical benefits – patient outcomes

• Cost effectiveness – savings to hospitals/health system

Source

1 “Operating Theatre Efficiency Guidelines-A guide to the efficient management of operating theatres in New South Wales hospitals” Agency for Clinical Innovation NSW May 2015

2 https://www.openanesthesia.org/or_costs_labor_vs_materials/

3 An Audit of Operating Room Time Utilization in a Teaching Hospital: Is There a Place for Improvement? George Stavrou,1 Stavros Panidis,1 John Tsouskas,1 Georgia Tsaousi,2 and Katerina Kotzampassi1 March 2014

4 Where Are the Costs in Perioperative Care?: Analysis of Hospital Costs and Charges for Inpatient Surgical Care Anesthesiology 12 1995, Vol.83, 1138-1144.: Alex Macario, MD, MBA; Terry Vitez, MD; Brian Dunn, BA; Tom McDonald, MD

5 Next Step in Cost Containment of Public Hospital Economy Could Be Merging of Anaesthesia and Surgery Budgets Jacob Rosenberg[*] and Thomas Fuchs-Buder 2016 Jul 19

Yours sincerely

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David Breeze Chairman

Enquiries should be directed to David Breeze +61 8 9328 8400 admin@bphenergy.com.au

CLINICAL USE OF THE BARM (with a current perspective on awareness monitoring in the operating theatre)

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DR ADRIAN SULTANA MD FRCP (Glasg) FANZCA Cortical Dynamics Symposium Conflicts of Interest: Nil

INDICATIONS FOR AWARENESS MONITORING

• ALL PATIENTS?

• ALL NMB BASED TECHNIQUES

• ALL TIVA

• HISTORY OF AWARENESS

• TRAUMA

• GA C/S

• CPB

• HIGH RISK? IVDU PSYCH MORBID ANXIETY BENZOS

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AWARENESS: INCIDENCE AND RISKS

• 1:19 000 for all anaesethetics -not for at risk

• Female

• Younger adults

• Obesity

• Previous awareness

• Emergencies

• Neuromuscular blockers

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==> picture [490 x 9] intentionally omitted <==

AWARENESS: HAVE YOU SEEN IT?

• I HAVE PERSONALLY REPORTED ONE CASE TO MY MDU – AWARENESS OF INTUBATION IN A CAUTIOUS TIVA INDUCTION OF A BARIATRIC PATIENT WITH CO-MORBID CARDIAC INSTABILITY

• PATIENT WAS HAPPY AFTER 2 SESSIONS OF COUNSELLING –NO pEEG AVAILABLE AT THAT HOSPITAL AT THAT TIME -2001

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AWARENESS MONITORING NOT NECESSARY DURING INHALATIONAL ?

• Private Hospital: Man was awake during tonsillectomy

• EXCLUSIVE Carleen Frost, The Daily Telegraph

• December 8, 2015 12:00am

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AWARENESS MONITORING NOT NECESSARY DURING INHALATIONAL ?

• Private Hospital: Man was awake during tonsillectomy

• EXCLUSIVE Carleen Frost, The Daily Telegraph

• December 8, 2015 12:00am

• A PATIENT having his tonsils removed at a Sydney hospital lived out a real-life nightmare when he “heard and felt what was happening” during the surgery after the anaesthetist failed to switch on the necessary sedation machine.

• The 34-year-old man told staff at the Private Hospital he suffered pain and emotional distress when he found himself awake but unable to properly move or communicate during the procedure in February 2013.

• His suffering became apparent during the routine tonsillectomy when staff noticed him twitching and his blood pressure rising.

• An inquiry into the incident found that while he had been given a neuromuscular block, the machine to administer an ongoing sedation gas was not turned on at the power point.

• Anaesthetist X told investigators he was “multi-tasking” during the surgery and had also checked a message on his mobile phone.

• He accepted that it was his responsibility to ensure the machine was switched on and working prior to the commencement of the procedure.

• “(The patient) was aware during most of the surgical procedure, which caused him not only significant discomfort but also emotional and psychological distress,” a report into the incident said.

• The Medical Council of NSW last week found Dr X guilty of unsatisfactory professional conduct and ordered him to undergo mentoring and complete a daylong course in anaesthesia safety.

• Private Hospital did not respond to a request for comment on the matter.

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EEG-based Anaesthesia Monitors

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NEUROsense

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IoC-view

Narcotrend

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aepEX

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----- Start of picture text -----

E-ENTROPY
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BIS
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SEDline
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SNAP
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EEG-based Anaesthesia Monitors

• All other current monitors use methods which extract features from EEG signals which correlate with behavioural assessments of sedation and hypnosis

• The analysis methods are therefore not based on physiological laws or equations

• Time delays of 14 to 155 seconds (between changes in patient state and the displayed measure) have been reported for the different devices (e.g. ~30sec for BIS)

• BARM has a realm of only 2 Seconds in detecting shifts in levels of consciousness

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Brain Anaesthesia Response (BAR) Monitor

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Brain Anaesthesia Response (BAR) Monitor

• The BAR Monitor uses processed electroencephalography (pEEG) to monitor the brain response to anaesthetic and sedative agents

• The BAR Monitor is the only monitor to use EEG analysis based on a model of brain electrical activity (Liley Model)

• Other monitors use methods that are empirical and

• not based on a physical law or equation

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How is the BAR Monitor Different?:

• A physiologically inspired method of EEG analysis allows more accurate monitoring during anaesthesia

• BAR indices provide measures of cortical as well as sub-cortical mechanisms

• Wider range of anaesthetic agents can be monitored

• Shifts in levels of consciousness reflected with only a

• 2-second delay

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 10] intentionally omitted <==

BAR Indices

• The state of the cortex as well as the magnitude of the subcortical input are quantified using two measures:

• Composite Cortical State (CCS)

• Cortical Input (CI)

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BAR Indices

• Composite Cortical State (CCS)

• represents the resonant state of the cortical filter

• Is shown to be a measure of hypnosis

• Cortical Input (CI)

• is a measure of input to the cortex from subcortical areas

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• Is shown to be a measure of analgesia

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BAR Monitor Display

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BAR Monitor Display

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BAR Studies

Validation

• Validation of the BAR Monitoring System during anaesthesia for cardiac surgery using two different doses of fentanyl

• Twenty-five patients scheduled to undergo elective first-time coronary artery bypass surgery (CABG) were tested at St. Vincent’s Hospital Melbourne

==> picture [165 x 71] intentionally omitted <==

Shoushtarian et al. (2015), Journal of Clinical Monitoring and Computing

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BAR Validation

• Patients were randomised to receive a low or medium dose of fentanyl:

• Fentanyl low dose (FLD, 12µg/kg)

• Fentanyl moderate dose (FMD, 24µg/kg)

• Study period:

Patient Fentanyl (1st dose) preparation

Fentanyl Skin (2[nd] dose) incision Time (s)

t -60s FENT2

t FENT2

Induction Maintenance Propofol Propofol

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BAR Studies

• Effect of propofol and remifentanil on frontal electroencephalographic activity

• 45 patients randomised to receive remifentanil levels of 0, 2 or 4 ng/ml

• All patients received stepwise-increased targeted effect-site concentrations of propofol

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Liley et al. (2010), Anesthesiology Sleigh 2010, Anesthesiology (editorial)

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BAR our patients at SLC AND SPH

• Elective arthroscopic shoulders: ISCB/Tci Remifentanil/Propofol

• (Complete Blocks)

• Elective arthroscopic knees/ ACL (No Block or FNB ) Tci Remifentanil/Propofol

• Tci

• Elective TSR/TKR with continuous ISCB or FNB Remifentanil/Propofol

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BAR our patients

• We also tried some inhalational cases superimposed on our basic block techniques and data were equally resilient.

• In addition we performed two cases with our OFA mixture of Lignocaine/Ketamine/Precedex with profound NMB and we were able to achieve accuracy, predictability and a smooth wake-up

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR PRO-CON

• Remarkably stable and responsive signal permitted a new level of “belief” in the awareness monitoring technique and allowed us to run cases at say 45 with confidence in early tapering of TCI

• Ease of application of sensor

• User-friendly interface

• Bulky “sim card”

• Unable to print but can store to USB

• Next generation: ?modules for GE and other common machines/monitoring systems

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BAR Monitor Display

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BAR Monitor Display

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BAR Monitor Benefits

Patient benefits

• Reduced risk of waking up or having recollections of surgical procedures or dreams during the surgical procedure

• Reduced risk of receiving too high a dose of anaesthetic agent which can lead to postoperative nausea and discomfort or permanent injury or death in the most severe cases

• Significantly improved outcomes particularly for patients at high risk of awareness

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor Benefits

Benefits to Anaesthetists

• Facilitate the use of the optimal dose of anaesthetic agent

• Facilitate the delivery of higher quality and more reliable service to hospitals and patients

• reduce the risk of litigation due to patients experiencing awareness during surgery

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor Benefits

Benefits to Hospital/ Day Clinics

• Improved likelihood of delivering a better service to patients

• Optimising the dose of anaesthetic agent used can reduce the use of anaesthetic agents, and improve patient turn-around times and lead to cost savings

• Reduced risk of litigation

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor

Next Generation Monitor of Anaesthesia

• A physiologically inspired method of EEG analysis allows more accurate monitoring during anaesthesia

• BAR indices

• CCS and CI provide measures of cortical as

• well as sub-cortical mechanisms

• Shifts in levels of consciousness are reflected with less delay compared to current monitors

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 10] intentionally omitted <==

BIBLIOGRAPHY

Shoushtarian M, McGlade DP, Delacretaz L, Liley D

Evaluation of the brain anaesthesia response monitor during anaesthesia for cardiac surgery: a double-blind,randomised controlled trial using two doses of fentanyl

,J Clin Monit Comput DOI 10.1007/s10877-015-9780-x

NAP5 5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland

Report and findings September 2014 PP 1-169

Hajat Z, Ahmad N, Andrzejowski J.

The role and limitations of EEG-based depth of anaesthesia

monitoring in theatres and intensive care

Anaesthesia 2017, 72 (Suppl. 1), 38–47 doi:10.1111/anae.13739

Depth of anaesthesia monitors –Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M Diagnostics guidance Published: 21 November 2012

nice.org.uk/guidance/dg6

https://www-uptodate-com.ezproxy.anzca.edu.au/contents/awareness-with-recall-following-generalanesthesia/

https://www.dailytelegraph.com.au/news/nsw/delmar-private-hospital-man-was-awake-duringtonsillectomy/news-story/cfcc5d14dc1efb7898267a88ec702103

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==> picture [490 x 10] intentionally omitted <==

CLINICAL USE OF THE BARM (with a current perspective on awareness monitoring in the operating theatre)

==> picture [311 x 165] intentionally omitted <==

DR ADRIAN SULTANA MD FRCP (Glasg) FANZCA Cortical Dynamics Symposium Conflicts of Interest: Nil

INDICATIONS FOR AWARENESS MONITORING

• ALL PATIENTS?

• ALL NMB BASED TECHNIQUES

• ALL TIVA

• HISTORY OF AWARENESS

• TRAUMA

• GA C/S

• CPB

• HIGH RISK? IVDU PSYCH MORBID ANXIETY BENZOS

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

AWARENESS: INCIDENCE AND RISKS

• 1:19 000 for all anaesethetics -not for at risk

• Female

• Younger adults

• Obesity

• Previous awareness

• Emergencies

• Neuromuscular blockers

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

AWARENESS: HAVE YOU SEEN IT?

• I HAVE PERSONALLY REPORTED ONE CASE TO MY MDU – AWARENESS OF INTUBATION IN A CAUTIOUS TIVA INDUCTION OF A BARIATRIC PATIENT WITH CO-MORBID CARDIAC INSTABILITY

• PATIENT WAS HAPPY AFTER 2 SESSIONS OF COUNSELLING –NO pEEG AVAILABLE AT THAT HOSPITAL AT THAT TIME -2001

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

AWARENESS MONITORING NOT NECESSARY DURING INHALATIONAL ?

• Private Hospital: Man was awake during tonsillectomy

• EXCLUSIVE Carleen Frost, The Daily Telegraph

• December 8, 2015 12:00am

==> picture [647 x 205] intentionally omitted <==

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

AWARENESS MONITORING NOT NECESSARY DURING INHALATIONAL ?

• Private Hospital: Man was awake during tonsillectomy

• EXCLUSIVE Carleen Frost, The Daily Telegraph

• December 8, 2015 12:00am

• A PATIENT having his tonsils removed at a Sydney hospital lived out a real-life nightmare when he “heard and felt what was happening” during the surgery after the anaesthetist failed to switch on the necessary sedation machine.

• The 34-year-old man told staff at the Private Hospital he suffered pain and emotional distress when he found himself awake but unable to properly move or communicate during the procedure in February 2013.

• His suffering became apparent during the routine tonsillectomy when staff noticed him twitching and his blood pressure rising.

• An inquiry into the incident found that while he had been given a neuromuscular block, the machine to administer an ongoing sedation gas was not turned on at the power point.

• Anaesthetist X told investigators he was “multi-tasking” during the surgery and had also checked a message on his mobile phone.

• He accepted that it was his responsibility to ensure the machine was switched on and working prior to the commencement of the procedure.

• “(The patient) was aware during most of the surgical procedure, which caused him not only significant discomfort but also emotional and psychological distress,” a report into the incident said.

• The Medical Council of NSW last week found Dr X guilty of unsatisfactory professional conduct and ordered him to undergo mentoring and complete a daylong course in anaesthesia safety.

• Private Hospital did not respond to a request for comment on the matter.

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

EEG-based Anaesthesia Monitors

==> picture [168 x 109] intentionally omitted <==

NEUROsense

==> picture [87 x 97] intentionally omitted <==

IoC-view

Narcotrend

==> picture [118 x 123] intentionally omitted <==

aepEX

==> picture [135 x 170] intentionally omitted <==

----- Start of picture text -----

E-ENTROPY
----- End of picture text -----

==> picture [188 x 116] intentionally omitted <==

==> picture [135 x 148] intentionally omitted <==

==> picture [136 x 95] intentionally omitted <==

==> picture [30 x 14] intentionally omitted <==

----- Start of picture text -----

BIS
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----- Start of picture text -----

SEDline
----- End of picture text -----

==> picture [50 x 14] intentionally omitted <==

----- Start of picture text -----

SNAP
----- End of picture text -----

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

EEG-based Anaesthesia Monitors

• All other current monitors use methods which extract features from EEG signals which correlate with behavioural assessments of sedation and hypnosis

• The analysis methods are therefore not based on physiological laws or equations

• Time delays of 14 to 155 seconds (between changes in patient state and the displayed measure) have been reported for the different devices (e.g. ~30sec for BIS)

• BARM has a realm of only 2 Seconds in detecting shifts in levels of consciousness

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

Brain Anaesthesia Response (BAR) Monitor

==> picture [337 x 226] intentionally omitted <==

==> picture [165 x 71] intentionally omitted <==

Brain Anaesthesia Response (BAR) Monitor

• The BAR Monitor uses processed electroencephalography (pEEG) to monitor the brain response to anaesthetic and sedative agents

• The BAR Monitor is the only monitor to use EEG analysis based on a model of brain electrical activity (Liley Model)

• Other monitors use methods that are empirical and

• not based on a physical law or equation

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 10] intentionally omitted <==

How is the BAR Monitor Different?:

• A physiologically inspired method of EEG analysis allows more accurate monitoring during anaesthesia

• BAR indices provide measures of cortical as well as sub-cortical mechanisms

• Wider range of anaesthetic agents can be monitored

• Shifts in levels of consciousness reflected with only a

• 2-second delay

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 10] intentionally omitted <==

BAR Indices

• The state of the cortex as well as the magnitude of the subcortical input are quantified using two measures:

• Composite Cortical State (CCS)

• Cortical Input (CI)

==> picture [165 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Indices

• Composite Cortical State (CCS)

• represents the resonant state of the cortical filter

• Is shown to be a measure of hypnosis

• Cortical Input (CI)

• is a measure of input to the cortex from subcortical areas

==> picture [276 x 187] intentionally omitted <==

• Is shown to be a measure of analgesia

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor Display

==> picture [536 x 374] intentionally omitted <==

==> picture [166 x 71] intentionally omitted <==

==> picture [513 x 10] intentionally omitted <==

BAR Monitor Display

==> picture [166 x 71] intentionally omitted <==

==> picture [513 x 10] intentionally omitted <==

BAR Studies

Validation

• Validation of the BAR Monitoring System during anaesthesia for cardiac surgery using two different doses of fentanyl

• Twenty-five patients scheduled to undergo elective first-time coronary artery bypass surgery (CABG) were tested at St. Vincent’s Hospital Melbourne

==> picture [165 x 71] intentionally omitted <==

Shoushtarian et al. (2015), Journal of Clinical Monitoring and Computing

==> picture [490 x 10] intentionally omitted <==

BAR Validation

• Patients were randomised to receive a low or medium dose of fentanyl:

• Fentanyl low dose (FLD, 12µg/kg)

• Fentanyl moderate dose (FMD, 24µg/kg)

• Study period:

Patient Fentanyl (1st dose) preparation

Fentanyl Skin (2[nd] dose) incision Time (s)

t -60s FENT2

t FENT2

Induction Maintenance Propofol Propofol

==> picture [490 x 9] intentionally omitted <==

BAR Studies

• Effect of propofol and remifentanil on frontal electroencephalographic activity

• 45 patients randomised to receive remifentanil levels of 0, 2 or 4 ng/ml

• All patients received stepwise-increased targeted effect-site concentrations of propofol

==> picture [166 x 71] intentionally omitted <==

Liley et al. (2010), Anesthesiology Sleigh 2010, Anesthesiology (editorial)

==> picture [490 x 9] intentionally omitted <==

BAR our patients at SLC AND SPH

• Elective arthroscopic shoulders: ISCB/Tci Remifentanil/Propofol

• (Complete Blocks)

• Elective arthroscopic knees/ ACL (No Block or FNB ) Tci Remifentanil/Propofol

• Tci

• Elective TSR/TKR with continuous ISCB or FNB Remifentanil/Propofol

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR our patients

• We also tried some inhalational cases superimposed on our basic block techniques and data were equally resilient.

• In addition we performed two cases with our OFA mixture of Lignocaine/Ketamine/Precedex with profound NMB and we were able to achieve accuracy, predictability and a smooth wake-up

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR PRO-CON

• Remarkably stable and responsive signal permitted a new level of “belief” in the awareness monitoring technique and allowed us to run cases at say 45 with confidence in early tapering of TCI

• Ease of application of sensor

• User-friendly interface

• Bulky “sim card”

• Unable to print but can store to USB

• Next generation: ?modules for GE and other common machines/monitoring systems

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor Display

==> picture [403 x 332] intentionally omitted <==

==> picture [166 x 71] intentionally omitted <==

==> picture [513 x 10] intentionally omitted <==

BAR Monitor Display

==> picture [536 x 374] intentionally omitted <==

==> picture [166 x 71] intentionally omitted <==

==> picture [513 x 10] intentionally omitted <==

BAR Monitor Benefits

Patient benefits

• Reduced risk of waking up or having recollections of surgical procedures or dreams during the surgical procedure

• Reduced risk of receiving too high a dose of anaesthetic agent which can lead to postoperative nausea and discomfort or permanent injury or death in the most severe cases

• Significantly improved outcomes particularly for patients at high risk of awareness

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor Benefits

Benefits to Anaesthetists

• Facilitate the use of the optimal dose of anaesthetic agent

• Facilitate the delivery of higher quality and more reliable service to hospitals and patients

• reduce the risk of litigation due to patients experiencing awareness during surgery

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor Benefits

Benefits to Hospital/ Day Clinics

• Improved likelihood of delivering a better service to patients

• Optimising the dose of anaesthetic agent used can reduce the use of anaesthetic agents, and improve patient turn-around times and lead to cost savings

• Reduced risk of litigation

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 9] intentionally omitted <==

BAR Monitor

Next Generation Monitor of Anaesthesia

• A physiologically inspired method of EEG analysis allows more accurate monitoring during anaesthesia

• BAR indices

• CCS and CI provide measures of cortical as

• well as sub-cortical mechanisms

• Shifts in levels of consciousness are reflected with less delay compared to current monitors

==> picture [166 x 71] intentionally omitted <==

==> picture [490 x 10] intentionally omitted <==

BIBLIOGRAPHY

Shoushtarian M, McGlade DP, Delacretaz L, Liley D

Evaluation of the brain anaesthesia response monitor during anaesthesia for cardiac surgery: a double-blind,randomised controlled trial using two doses of fentanyl

,J Clin Monit Comput DOI 10.1007/s10877-015-9780-x

NAP5 5th National Audit Project of The Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland

Report and findings September 2014 PP 1-169

Hajat Z, Ahmad N, Andrzejowski J.

The role and limitations of EEG-based depth of anaesthesia

monitoring in theatres and intensive care

Anaesthesia 2017, 72 (Suppl. 1), 38–47 doi:10.1111/anae.13739

Depth of anaesthesia monitors –Bispectral Index (BIS), E-Entropy and Narcotrend-Compact M Diagnostics guidance Published: 21 November 2012

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