RT Book, Section
A1 Keifer, John C.
A1 Cruz-Navarro, Jovany
A1 Borel, Cecil O.
A1 McDonagh, David L.
A2 Longnecker, David E.
A2 Mackey, Sean C.
A2 Newman, Mark F.
A2 Sandberg, Warren S.
A2 Zapol, Warren M.
SR Print(0)
ID 1144116183
T1 Intraoperative Neurologic Monitoring
T2 Anesthesiology, 3e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071848817
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1144116183
RD 2024/04/19
AB KEY  POINTSAnesthetic  strategies  to  enhance  intraoperative  monitoring  of  the  nervous  system  include  techniques  that  minimize  interference  with  neurophysiologic  monitoring  as  well  as  techniques  that  preserve  neurocognitive  function  during  structural  and  functional  mapping  in  awake  patients.The  cellular  basis  of  normal  electroencephalography  (EEG)  reveals  a  variety  of  pathways  to  produce  alterations  of  electrical  and  neurocognitive  function.Synchronous  EEG  is  seen  with  sleep,  sedation  and  anesthesia,  and  cerebral  ischemia.Processed  EEG  algorithms  can  aid  the  objective  assessment  of  EEG  changes.  As  long  as  there  is  an  understanding  of  the  EEG  features  analyzed  by  these  algorithms,  pitfalls  leading  to  inaccurate  assessment  can  be  avoided.Achieving  reliability  with  evoked  potential  monitoring  depends  on  minimizing  anesthetic  effects,  maintaining  constant  anesthetic  levels,  and  ensuring  adequate  tissue  perfusion.Intraoperative  wakefulness  for  cortical  mapping  has  been  achieved  by  a  variety  of  techniques.  For  a  successful  procedure,  all  techniques  must  address  maintenance  of  effective  ventilation  during  craniotomy  and  a  balance  of  clear  sensorium  and  sufficient  analgesia  to  enable  effective  patient  participation.Intraoperative  computed  tomography  (iCT),  intraoperative  magnetic  resonance  imaging  (iMRI),  and  biplanar  angiography  are  opening  a  whole  new  realm  of  real-time  anatomic  and  physiologic  monitoring  that  will  further  enhance  neurosurgical  patient  outcomes.  It  is  essential  that  the  anesthesiologist  have  a  clear  understanding  of  these  technologies  to  facilitate  the  neurosurgical  intervention  while  maximizing  patient  safety.