Badenes Rafael, García-Pérez María L, Bilotta Federico
aDepartment of Anesthesiology and Surgical-Trauma Intensive Care, Hospital Clinic Universitari Valencia, University of Valencia, Valencia, SpainbDepartment of Anesthesiology, Critical Care and Pain Medicine, 'Sapienza' University of Rome, Rome, Italy.
Curr Opin Anaesthesiol. 2016 Oct;29(5):576-81. doi: 10.1097/ACO.0000000000000371.
This review reports recent evidence on intraoperative monitoring of cerebral oximetry and depth of anaesthesia during neuroanaesthesia procedures.
The clinical benefits of intraoperative monitoring with cerebral oximetry [near infrared spectroscopy (NIRS) and brain tissue oxygenation monitoring (brptiO2)] and depth of anaesthesia with bispectral index (BIS) have recently been studied in surgical (carotid endarterectomy, cerebral arteriovenous malformations resection and brain tumour resections) and neuroradiological vascular procedures. BrptiO2/PaO2 ratio is much more reliable than absolute brptiO2 readings in detecting hypoxia in arteriovenous malformation resections. NIRS can help clinicians monitor those patients receiving endovascular treatment for acute ischaemic stroke and during carotid endarterectomy, but the value of applying cerebral oximetry in patients with cerebral vasospasm needs to be further evaluated. Awake craniotomy demonstrated that because of considerable pharmacokinetic/pharmacodynamic interindividual variation, BIS titration is recommended. Thus, the presence of a frontal brain tumour did not affect ipsilateral BIS values.
Recent studies provide interesting evidence of intraoperative monitoring of NIRS, brptiO2 and BIS. The brptiO2/PaO2 ratio is much more reliable than an absolute brptiO2 reading; NIRS helps clinicians to monitor patients who are undergoing endovascular treatment, and BIS guides the titration of anaesthesia during awake craniotomy; its values are not affected by the presence of a frontal brain tumour.
本综述报告了神经麻醉手术期间脑氧饱和度和麻醉深度术中监测的最新证据。
最近在外科手术（颈动脉内膜切除术、脑动静脉畸形切除术和脑肿瘤切除术）和神经放射血管手术中研究了使用脑氧饱和度监测（近红外光谱法（NIRS）和脑组织氧合监测（brptiO2））和双谱指数（BIS）进行麻醉深度监测的临床益处。在动静脉畸形切除术中检测缺氧时，brptiO2/PaO2比值比绝对brptiO2读数可靠得多。NIRS可帮助临床医生监测接受急性缺血性卒中血管内治疗的患者以及颈动脉内膜切除术期间的患者，但在脑血管痉挛患者中应用脑氧饱和度监测的价值有待进一步评估。清醒开颅手术表明，由于药代动力学/药效学个体差异较大，建议采用BIS滴定法。因此，额叶脑肿瘤的存在并不影响同侧BIS值。
最近的研究为NIRS、brptiO2和BIS的术中监测提供了有趣的证据。brptiO2/PaO2比值比绝对brptiO2读数可靠得多；NIRS有助于临床医生监测接受血管内治疗的患者，BIS在清醒开颅手术期间指导麻醉滴定；其值不受额叶脑肿瘤存在的影响。
