Department of Neurosurgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States.
Handb Clin Neurol. 2022;186:83-99. doi: 10.1016/B978-0-12-819826-1.00003-X.
While intra-operative neuro-physiologic assessment and monitoring improve the safety of patients, its use may also introduce new risks of injuries. This chapter looks at the electric safety of equipment and the potential hazards during the set-up of the monitoring. The physical and functional physiologic effects of electric shocks and stimulation currents, standards for safety limits, and conditions for tissue damage are described from basic physical principles. Considered are the electrode-tissue interface in relation to electrode dimensions and stimulation parameters as applied in various modalities of evoked sensory and motor potentials as to-date used in intra-operative monitoring, mapping of neuro-physiologic functions. A background is given on circumstances for electric tissue heating and heat drainage, thermal toxicity, protection against thermal injuries and side effects of unintended activation of neural and cardiac tissues, adverse effects of physiologic amplifiers from transcranial stimulation (TES) and excitotoxicity of direct cortical stimulation. Addressed are safety issues of TES and measures for prevention. Safety issues include bite and movement-induced injuries, seizures, and after discharges, interaction with implanted devices as cardiac pacemaker and deep brain stimulators. Further discussed are safety issues of equipment leakage currents, protection against electric shocks, and maintenance.
术中神经生理评估和监测提高了患者的安全性，但它的使用也可能带来新的损伤风险。本章着眼于设备的电气安全以及监测设置过程中的潜在危险。从基本物理原理出发，描述了电击和刺激电流的物理和功能生理效应、安全限制标准以及组织损伤条件。考虑了与各种诱发感觉和运动电位模式中应用的电极尺寸和刺激参数相关的电极-组织界面，这些模式迄今为止已用于术中监测、神经生理功能的定位。介绍了电组织加热和热耗散、热毒性、防止热损伤以及意外激活神经和心脏组织的副作用、经颅刺激（TES）的生理放大器的不良反应和皮质直接刺激的兴奋毒性的情况。讨论了 TES 的安全问题和预防措施。安全问题包括咬伤和运动引起的损伤、癫痫发作和后放电，以及与植入式设备（如心脏起搏器和深部脑刺激器）的相互作用。进一步讨论了设备漏电流、电击防护和维护的安全问题。
