Bispectral index: comparison of two montages

We have compared fronto-central and bifrontal montages using a new EEG monitor, the Aspect A-1000. The monitor uses bispectral analysis to derive an index of anaesthetic depth, the bispectral index (BIS). We compared reliability, impedance and BIS for each montage. ECG electrodes placed in a bifrontal montage were more reliable than silver dome electrodes in a fronto-central montage and both types of electrodes had impedances in the clinically useful range. However, BIS values derived from each montage were found to differ in an unpredictable manner. The bifrontal montage is easy to apply and reliable but it is not comparable with a fronto-central montage. We conclude that the BIS may be useful for following trends in anaesthetic depth in individual cases but it is less helpful when making comparison between patients or as a single value.