Cerebral Monitoring in the Operating Room and the Intensive Care Unit
[Book]
by Enno Freye.
Dordrecht
Springer Netherlands
1990
(196 pages)
Developments in critical care medicine and anaesthesiology, 22.
1. Introduction --;1.1 Rationale for the use of cerebral monitoring in the OR and the ICU --;1.2 Why monitor the brain --;1.3 The neurological approach to EEG interpretation --;2. The principle of EEG recording using computerized power spectral analysis --;2.1 Difference with conventional EEG recording --;2.2 Electrode placement --;2.3 Technical requirements to obtain a reliable EEG signal (amplifiers, filters) --;2.4 The recording procedure --;2.5 Display techniques of the EEG --;2.6 Artifact rejection during processed EEG measurement --;2.7 Signal conduction and conversion --;3. Set-up of monitoring the EEG: The electrode montage --;4. Anesthesia and the EEG --;4.1 Rationale for the use of the EEG in anesthesia --;4.2 Inhalational agents and their effect on the EEG (N2O, halothane, enflurane, isoflurane) --;4.3 Intravenous agents and their effect on the EEG (barbiturates, etomidate, ketamine, opioids, benzodiazepines, propofol, CO2) --;5. The EEG and cerebral ischemia --;5.1 Differentiation between ischemia and anesthetic-induced EEG changes --;5.2 Cerebral monitoring during hypothermia and extracorporeal circulation (ECC) --;5.3 EEG monitoring during carotid endarterectomy --;6. Cerebral monitoring in the intensive care unit --;6.1 Introduction: Representative case reports --;6.2 EEG power spectra to differentiate between severe head trauma and drug overdose --;6.3 Symptoms of irreversible cessation of functions of the brain including the brain stem --;6.4 Avoiding false interpretation of EEG signal --;6.5 EEG power spectra during sleep --;7. Trouble shooting --;8. Systems currently available for processed EEG recording --;8.1 Introduction --;8.2 Description of units used for EEG power spectral analysis in the OR and the ICU --;9. Sensor Evoked Potentials (SEPs) --;9.1 What they are and what they offer --;9.2 Rationale for the use of EPs in the OR and the ICU --;9.3 The classification of EPs --;10. The principle of Somatosensory Evoked Potential monitoring --;10.1 Electrode types --;10.2 Procedure for locating the exact stimulus site --;10.3 The stimulus necessary for SEP recording --;10.4 Recording electrodes --;10.5 Procedure for head measurements to determine electrode location --;10.6 Accessory for electrode placement and removal --;10.7 Connection of electrodes with the preamplifier --;10.8 Trouble shooting to eliminate high impedance and electrical noise --;10.9 The differential amplifier for EEG and EP measurements --;11. Optimising signal to-noise ratio --;11.1 Introduction --;11.2 Procedure to locate the optimal stimulus site --;11.3 Alternating recording and stimulus sites --;12. Evaluating the response of the evoked potential --;12.1 Median nerve evoked potential --;12.2 The posterior tibial nerve evoked potential --;12.3 Criteria for abnormalities of both median and posterior tibial evoked potential --;13. The effect of drugs on the evoked potential --;13.1 Application of SEP monitoring in the clinical setting --;13.2 Representative examples of SEP traces at different clinical situations --;13.3 Postoperative use of SEPs --;14. Use of evoked potentials in the ICU --;14.1 Introduction --;14.2 SEPs in the diagnosis of lesions in the plexus of the upper extremities and in cervical root lesions --;14.3 Use of SEP monitoring in head trauma, vascular disease, and brain death --;14.4 Pitfalls and pointers for SEP measurement in the OR and the ICU --;15. Auditory Evoked Potentials (AEPs) and Brainstem Auditory Evoked Response (BAER or BAEP) --;15.1 Auditory Evoked Potentials --;15.2 Clinical applications of BAER --;16. Visual Evoked Potentials (VEPs) --;Summary on the application of intraoperative EP monitoring --;17. Complications that arise during EP monitoring --;18. Systems of use for EP measurements in the OR and the ICU --;19. New scopes in cerebral monitoring by topographic mapping of EEG-power spectra and EP waves --;20. Appendix --;20.1 Care of electrodes --;20.2 Summary of the clinical applications of EP monitoring in the OR --;20.3 Summary of the clinical applications of EP monitoring in the ICU --;21. Glossary --;22. Bibliography --;Index of subjects.
In spite of today's increasing body of knowledge in regard to central nervous func- tion and/or the mode of action of centrally active compounds, little is done to monitor those patients which are at risk of cerebral lesions either in the OR or in the ICU.