Michels P, Bräuer A, Bauer M, Söhle M
Klinik für Anästhesiologie, Universitätsklinikum Göttingen, Robert-Koch-Str. 40, 37079, Göttingen, Deutschland.
Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Bonn, Bonn, Deutschland.
Anaesthesist. 2017 Sep;66(9):645-659. doi: 10.1007/s00101-017-0356-7.
The application of intraoperative neurophysiological monitoring (IONM) is gaining more and more importance in daily clinical practice. The use of IONM allows the localization of neural structures and to control functioning of the peripheral and central nervous systems in anesthetized patients. This enables surgeons to identify and to protect neural structures and cerebral areas. The use of IONM also enables anesthesiologists to adjust anesthesia and cardiopulmonary therapy to the individual needs of the patient. Thereby, it may be possible to reduce the incidence of postoperative delirium and the incidence of postoperative cognitive deficits. To exploit the full potential anesthesiologists and surgeons must be able to use the methods of IONM safely and understand the results; therefore, basic knowledge of the technology, options and limitations of IONM is necessary. It is also important to be aware of the influence of anesthetics on the methods of IONM. Total intravenous anesthesia (TIVA) is the anesthetic method of choice, because it has only minimal influence on IONM methods. It is important to avoid bolus injections of hypnotics to achieve stable blood concentrations. Long- acting neuromuscular blocking agents should be avoided, because they disturb the signals of electromyography and motor-evoked potentials. By using IONM anesthesiologists and surgeons can identify changes in the function of the peripheral and central nervous system prior to irreversible damage.
术中神经生理监测（IONM）在日常临床实践中的应用正变得越来越重要。IONM的使用能够定位神经结构，并在麻醉患者中控制外周和中枢神经系统的功能。这使外科医生能够识别并保护神经结构和脑区。IONM的使用还使麻醉医生能够根据患者的个体需求调整麻醉和心肺治疗。因此，有可能降低术后谵妄的发生率和术后认知功能障碍的发生率。为了充分发挥其潜力，麻醉医生和外科医生必须能够安全地使用IONM方法并理解其结果；因此，掌握IONM技术、选项和局限性的基本知识是必要的。了解麻醉剂对IONM方法的影响也很重要。全静脉麻醉（TIVA）是首选的麻醉方法，因为它对IONM方法的影响最小。为达到稳定的血药浓度，避免推注催眠药很重要。应避免使用长效神经肌肉阻滞剂，因为它们会干扰肌电图和运动诱发电位的信号。通过使用IONM，麻醉医生和外科医生可以在发生不可逆损伤之前识别外周和中枢神经系统功能的变化。
