Grosland Jeffrey O, Todd Michael M, Goldstein Peter A
Department of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota.
Department of Anesthesiology.
Curr Opin Anaesthesiol. 2018 Dec;31(6):667-672. doi: 10.1097/ACO.0000000000000654.
Various neurologically focused monitoring modalities such as processed electroencephalography (pEEG), tissue/brain oxygenation monitors (SbO2), and even somatosensory evoked responses have been suggested as having the potential to improve the well tolerated and effective delivery of care in the setting of outpatient surgery. The present article will discuss the pros and cons of such monitors in this environment.
There is a paucity of evidence from rigorous, well designed clinical trials demonstrating that the routine use of any neuromonitoring technique in an ambulatory surgery setting leads to meaningful cost savings or a reduction in morbidity or mortality.
The use of advanced neuromonitoring techniques (primarily pEEG) may be considered reasonable in two instances: for the prevention of intraoperative awareness during the administration of total intravenous anesthesia coupled with the use of a neuromuscular blocking drug, and for the prevention of relative drug overdose (and possibly postoperative delirium) in the elderly.
各种以神经学为重点的监测方式，如处理后的脑电图（pEEG）、组织/脑氧合监测器（SbO2），甚至体感诱发电位，都被认为有可能在门诊手术中改善耐受性良好且有效的护理服务。本文将讨论此类监测器在这种环境下的利弊。
缺乏来自严格、精心设计的临床试验的证据，证明在门诊手术环境中常规使用任何神经监测技术能带来显著的成本节约或降低发病率或死亡率。
在两种情况下，使用先进的神经监测技术（主要是pEEG）可能被认为是合理的：一是在使用全静脉麻醉并联合使用神经肌肉阻滞剂时预防术中知晓，二是在老年人中预防相对药物过量（以及可能的术后谵妄）。
