BACKGROUND AND OBJECTIVES: The bispectral index (BIS) is a multifactorial parameter derived from the electroencephalogram (EEG), which allows monitoring of the hypnotic component of anesthesia. It was obtained from the algorithm based on the analysis of a large number of EEGs from volunteers and patients undergoing sedation and general anesthesia with different anesthetic agents. The use of BIS to monitor the depth of anesthesia reduces the incidence of intraoperative awakening and recall, among other benefits. The objective of this review was to present clinical situations in which the BIS gives false results, either elevated or decreased, due to conditions related to the patient or anesthetic actions unforeseen when the algorithm was elaborated. CONTENTS: The bispectral index can be altered and influenced in different clinical situations in which abnormal EEG patterns are present; the effects of different anesthetics and other drugs not included when the algorithm was elaborated; interference from electrical equipment; as well as peculiarities of the monitor. CONCLUSIONS: Although the BIS algorithm underwent several changes since its first version, the anesthesiologist should be aware of situations that cause false BIS readings to avoid complications, may it be secondary to anesthetic overdose or underdosing, which might cause intraoperative awakening and recall.
ANESTHESIA; MONITORING; MONITORING