When anesthesia is given without a brain monitor (i.e. the 20th century model of anesthesia care), over-medication is always given for fear of under medication or anesthesia awareness.
The customary monitors (EKG, pulse oximeter, & blood pressure) do a fine job of measuring your brain STEM function. However, thinking, hearing, feeling and remembering are CORTICAL functions.
Brain stem measurements are notoriously unreliable measures of your cortical function. Poor or sub-optimal cortical function is revealed in brain fog or POCD.
FYI, the only post-anesthesia brain function test you will get is ‘able to move all 4 extremities on command,’ an abysmally low level of cortical function.
Only a brain monitor like the BIS measures your cortical function.
The public education message of my non-profit Goldilocks Anesthesia Foundation is simple & direct:
“No surgery under anesthesia without a brain monitor.”
That message is contained within the first line of Friedberg’s Triad
“Measure the brain”
If one follows the second part,
“Preempt the pain”
or 50 mg ketamine 3-5 minutes pre-incision (aka ‘the nifty fifty’),
the need for postop narcotics (opioids) is essentially eliminated
“Emetic drugs abstain”
means no need to give anti-nausea medication to treat narcotic associated postoperative nausea and vomiting (PONV).
Anesthesia awareness is the least important function of a brain monitor.
The avoidance of the nefarious practice of routine over-medication is clearly the greatest benefit of routine brain monitoring (i.e. the 21st century model of anesthesia care).
FWIW, anesthesia fog or POCD lasting more than a year is called anesthesia dementia that, unfortunately, does not go away.
I hope all those affected with POCD resolve in less than a year.
BIS brain monitors can be found in 75% of US hospitals but only used 25% of the time simply because patients do not know to DEMAND them for surgery under anesthesia.
While there may well be many factors involved in POCD, why let anyone play Russian roulette with your brain if you must have surgery?