"Listen, John, there's a ton of variability of between how much prop a fellow needs. It's not like iso. You start doing a lot of TIVA at your level of experience and you don't use the BIS, then you are going to have awareness and ruin someone's life."

The MDA was concerned that the patient would drop her BP and I would just turn down the prop and end up without enough anesthesia on board.

The thing is now I'm at a facility where the propofol is plentiful, but BIS monitors are not. Am I playing Russian roulette every time I rely on prop alone as an anesthetic in a paralyzed patient?