Central Nervous System Monitoring in Anesthesia and Intensive Care

Research in electrophysiologic monitoring in anesthesia and intensive care has focussed mostly on questions pertinent for patient care: First how to quantitate drug effects on brain electrical activity and the degree of anesthetic-induced suppression of the central nervous system. Second, how to monitor functional impairment following cerebral ischemia and hypoxia. And third, how to differ entiate between drug-induced effects on the central nervous system and deleteri ous events related to reductions in cerebral blood flow and/or oxygen delivery. Even though progress has been achieved over the last 10 years in this field and fascinating new techniques have been developed, it is still not clear which monitor parameter will provide adequate information on the depth of anes thesia and the analgesic level. Because the central nervous system has been one of the main research areas in our department over the last 10 years, we organized a workshop to summarize the latest developments in central nervous system monitoring. This book comprises the topics of this workshop and is intended to provide insight into the current status of central nervous system monitoring, elucidating possible indications and delineating its limitations.

Autorentext
Eberhard Kochs ist Direktor der Klinik für Anaesthesiologie der Technischen Universität München, Klinikum rechts der Isar.

Klappentext

The book is based on papers presented at the recently heldinternational meeting on central-nervous-system monitoringin Hamburg, Germany. Experts inthe fields ofneurophysiology, experimental and clincial anesthesia andintensive care discussed the state of the art innoninvasive central-nervous-system monitoring. Startingwith the principles of CNS monitoring in humans, the topicscovered include pharmacokinetic pharmacodynamicinteractions, the usefulness of spontaneous and evoked brainelectrical activity as an overall-control for afferentsystems andfor the assessment of analgesic drug treatment,perioperative anesthesiological monitoring, andintraoperative awareness. Recently developed specific EEGand EP indices such as spectral edge frequency, medianfrequency, auditory and somatosensory evoked responses forthe assessment of depth of anesthesia are evaluated forintraoperative monitoring. The surgical andanesthesiological perspective in intraoperativemonitoringduring vascular surgery are presented, as is the state oftheart in the monitoring of afferent central-nervous-systempathways by monitoring transcranial motor evoked potentials.Bispectral EEG analysis forthe assessment of anestheticadequacy represents the future trend in intraoperativemonitoring. In addition to neurophysiological methods,assessment of jugular bulb venous oxygen saturation andtranscranial Doppler sonography may give additionalinformation for the interpretation of brain fuction. In thefield of intensive care, topics in multimodal long-termmonitoring of brain function are presented. The applicationof an expert system supporting the diagnosis of brain deathis also included.

Inhalt
I Monitoring of the ElectroencephalogramFundamentals.- Interactions of Anesthetics at Different Levels of the Central Nervous System.- Principles of Central Nervous System Monitoring in Humans.- II Techniques and Applications ofElectroencephalogram-Monitoring.- Pharmacokinetic and Pharmacodynamic Interactions Relevant To Cerebral Monitoring.- Electroencephalographic Feedback Control of Anesthetic Drug Administration.- The Use of Processed EEG in the Operating Room.- Bispectral Electroencephalogram Analysis for Monitoring Anesthetic Adequacy.- Does Spectral Edge Frequency Assess Depth of Anesthesia?.- Paradoxical Arousal During Isoflurane/Nitrous Oxide Anesthesia: Quantitative Topographical EEG Analysis.- Central Nervous System Monitoring; Reduction of Information Content of Quantitative Electroencephalograms for Continuous On-Line Display During Anesthesia.- III Monitoring of Stimulus Evoked Responses.- Central Evoked Brain Potential as Overall Control of Afferent Systems.- Indication for Evoked Potential Monitoring: A Surgical View.- Anesthesia and Somatosensory Evoked Responses.- Peri-operative Anesthesiological Monitoring of Auditory-Evoked Potentials.- The 40-Hz Auditory Steady State Response for Monitoring Level of Consciousness: Methodological Considerations.- Motor Evoked Potentials.- IV Evoked Response: Special Applications.- Auditory Evoked Potentials to Monitor Intra-operative Awareness.- Evoked Potential Monitoring for Vascular Surgery.- Assessment of Analgesic Drug Treatment.- Long-Term Monitoring in Intensive Care Patients: Electroencephalogram, Evoked Responses, and Brain Mapping.- V Present and Future Trends in Cerebral Monitoring.- Present and Future Trends in Multimodal Cerebral Monitoring in Anesthesia and Intensive Care.- Jugular Bulb VenousOxygen Saturation and Transcranial Doppler Ultrasonography in Neurosurgical Patients.- Transcranial Doppler Sonography: Monitoring of Cerebral Perfusion.- BRAINDEXAn Expert System for Supporting Brain Death Diagnosis.