Guignard Bruno
Département d'Anesthésie Réanimation, Hôpital Ambroise Paré, 9 avenue du général de Gaulle, 92100 Boulogne Billancourt, France.
Best Pract Res Clin Anaesthesiol. 2006 Mar;20(1):161-80. doi: 10.1016/j.bpa.2005.09.002.
Analgesia (pain relief) amnesia (loss of memory) and immobilisation are the three major components of anaesthesia. The perception of pain, and therefore, the need for analgesia, is individual, and the monitoring of analgesia is indirect and, in essence, of the moment. Under general anaesthesia, analgesia is continually influenced by external stimuli and the administration of analgesic drugs, and cannot be really separated from anaesthesia: the interaction between analgesia and anaesthesia is inescapable. Autonomic reactions, such as tachycardia, hypertension, sweating and lacrimation, although non-specific, are always regarded as signs of nociception or inadequate analgesia. Autonomic monitoring techniques, such as the analysis of heart rate variability, laser Doppler flowmetry, phlethysmographically derived indices and the pupillary light reflex, may help to quantitate reactions of the autonomic nervous system. For the past few years, automated electroencephalographic analysis has been of great interest in monitoring anaesthesia and could be useful in adapting the peroperative administration of opioids. A range of information collected from the electroencephalogram, haemodynamic readings and pulse plethysmography might be necessary for monitoring the level of nociception during anaesthesia. Information theory, multimodal monitoring, and signal processing and integration are the basis of future monitoring.
镇痛（缓解疼痛）、失忆（记忆丧失）和制动是麻醉的三个主要组成部分。疼痛的感知，以及因此对镇痛的需求，因人而异，而且镇痛的监测是间接的，本质上是即时性的。在全身麻醉下，镇痛持续受到外部刺激和镇痛药物给药的影响，并且无法真正与麻醉分离：镇痛与麻醉之间的相互作用是不可避免的。自主反应，如心动过速、高血压、出汗和流泪，虽然不具有特异性，但一直被视为伤害感受或镇痛不足的迹象。自主监测技术，如心率变异性分析、激光多普勒血流仪、容积描记衍生指标和瞳孔光反射，可能有助于量化自主神经系统的反应。在过去几年中，自动脑电图分析在麻醉监测方面引起了极大兴趣，并且可能有助于调整术中阿片类药物的给药。为了监测麻醉期间的伤害感受水平，可能需要从脑电图、血流动力学读数和脉搏容积描记法收集一系列信息。信息论、多模式监测以及信号处理与整合是未来监测的基础。
