RT Book, Section
A1 Keifer, John C.
A1 Borel, Cecil O.
A2 Longnecker, David E.
A2 Brown, David L.
A2 Newman, Mark F.
A2 Zapol, Warren M.
SR Print(0)
ID 56631465
T1 Chapter 33. Intraoperative Neurologic Monitoring
T2 Anesthesiology, 2e
YR 2012
FD 2012
PB The McGraw-Hill Companies
PP New York, NY
SN 978-0-07-178513-6
LK accessanesthesiology.mhmedical.com/content.aspx?aid=56631465
RD 2024/04/24
AB Anesthetic  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  the  structure  and  function  mapping  in  the  awake  patient.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  effect,  maintaining  a  constant  anesthetic  level,  and  ensuring  adequate  nervous  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  during  cortical  mapping.Subarachnoid  block  for  placement  of  epidural  stimulating  electrodes  allows  for  maintained  patient  perception  of  electrode  stimulation  while  providing  effective  anesthesia  for  laminotomy.