Fukuda Satoru
Department of Anesthesiology & Pain Medicine, Faculty of Medical Science, University of Fukui, Fukui 910-1193.
Masui. 2006 Mar;55(3):264-8.
The aims of the neuromonitoring during perioperative period are 1) to detect the brain, spinal cord and peripheral nerve ischemia immediately and hence prevention from neuronal injury, 2) to measure the depth of anesthesia, especially sedative effect of anesthetics and 3) to evaluate brain death. For the detection of brain and spinal cord ischemia during operation, we have to bear in mind 1) whether we truly monitor the possible ischemic risk sites in the brain and spinal cord; 2) whether we know the false-negative and false-positive ratio of the neuromonitoring with account being taken of the effect of anesthetics, the patient's own pathologies, the body temperature etc. If we detect the abnormal change through neuromonitoring, we should immediately warn the surgeon to improve his subsequent procedures and confirm his decision to prevent neuronal damage. To understand these reviews, we have to know the fundamental basic knowledge such as International 10-20 System on EEG monitoring, the expression of negative wave and positive wave in evoked potential, the meaning of near-field potential and far-field potential, temporal dispersion and so on. In this issue, the recent progress in neuromonitoring is described by the specialists in each fields. I hope the anesthesiologists understand the significance of neuromonitoring and apply these techniques for the patient undergoing the neurological operation during perioperative periods.
1)立即检测脑、脊髓和周围神经缺血,从而预防神经元损伤;2)测量麻醉深度,尤其是麻醉药的镇静效果;3)评估脑死亡。为了在手术期间检测脑和脊髓缺血,我们必须牢记:1)我们是否真正监测了脑和脊髓中可能的缺血风险部位;2)考虑到麻醉药的作用、患者自身的病理状况、体温等因素,我们是否了解神经监测的假阴性和假阳性率。如果我们通过神经监测检测到异常变化,应立即提醒外科医生改进其后续操作,并确认其预防神经元损伤的决策。为了理解这些内容,我们必须了解一些基本的基础知识,如脑电图监测的国际10-20系统、诱发电位中负波和正波的表达、近场电位和远场电位的含义、时间离散等。在本期中,各领域的专家介绍了神经监测的最新进展。我希望麻醉医生能够理解神经监测的重要性,并将这些技术应用于围手术期接受神经外科手术的患者。