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

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

For further information please see the following presentation on the trials:


  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
  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