医学
麻醉剂
麻醉
神经肌肉阻滞
体感诱发电位
突发抑制
神经科学
封锁
脑电图
心理学
内科学
受体
精神科
作者
Tod B. Sloan,Éric Heyer
出处
期刊:Journal of Clinical Neurophysiology
[Ovid Technologies (Wolters Kluwer)]
日期:2002-10-01
卷期号:19 (5): 430-443
被引量:300
标识
DOI:10.1097/00004691-200210000-00006
摘要
Summary Intraoperative neurophysiologic monitoring (INM) using somatosensory and motor evoked potentials (MEPs) has become popular to reduce neural risk and to improve intraoperative surgical decision making. Intraoperative neurophysiologic monitoring is affected by the choice and management of the anesthetic agents chosen. Because inhalational and intravenous anesthetic agents have effects on neural synaptic and axonal functional activities, the anesthetic effect on any given response will depend on the pathway affected and the mechanism of action of the anesthetic agent (i.e., direct inhibition or indirect effects based on changes in the balance of inhibitory or excitatory inputs). In general, responses that are more highly dependent on synaptic function will have more marked reductions in amplitude and increases in latency as a result of the synaptic effects of inhalational anesthetic agents and similar effects at higher doses of intravenous agents. Hence, recording cortical somatosensory evoked potentials and myogenic MEPs requires critical anesthetic choices for INM. The management of the physiologic milieu is also important as central nervous system blood flow, intracranial pressure, blood rheology, temperature, and arterial carbon dioxide partial pressure produce alterations in the responses consistent with the support of neural functioning. Finally, the management of pharmacologic neuromuscular blockade is critical to myogenic MEP recording in which some blockade may be desirable for surgery but excessive blockade may eliminate responses. A close working relationship of the monitoring team, the anesthesiologist, and the surgeon is key to the successful conduct and interpretation of INM.
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