Neuro monitoring in anesthesia
Prepared by:
Animut T.(MSc, BSc in Anesthesia)
Introduction
• Intraoperative neurophysiological monitoring
(IOM) is evolving toward a standard of care to
minimise the risk of injury to neural pathways
during neurosurgical procedures.
• Its importance lies not only in diagnosing
injury but also in creating a window of
opportunity to salvage neural tissues at risk
before damage becomes irreversible.
Cont…
• The goal of monitoring is to alert the surgeon
and anesthetit to impending injury in order to
allow modification of management in time to
prevent permanent damage.
• In some cases, neuromonitoring is used to
map areas of the nervous system in order to
guide procedural management.
Cont…
• Techniques for monitoring fall into 2 broad
categories:
1. Technique to assess metabolic integrity of the
nervous system
– global or regional determinations of blood flow or
oxygenation
2. Techniques to assess functional integrity:
– Global or focused on specific anatomic pathways or
structures of the nervous system.
• Continuous or frequent intermittent basis
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• There are several commercial depth-of-anesthesia
monitors currently on the market.
• They all attempt to convert the frontal EEG signal into a
dimensionless index
• values ranging from 0 to 100, with 0 representing no
electrical activity and 100 a fully responsive.
• Bispectral index
• SedLine
• Narcotrend
• MEntropy
that all use the processed spontaneous EEG.
Cont…
• Perioperative uses of EEG:
1. To identify inadequate blood flow to cerebral cortex
– Surgically induced
– anesthetic-induced
– retraction on cerebral tissue.
2. To guide an anesthetic-induced reduction of cerebral
metabolism
– anticipation of a loss of CBF
– Treatment of high intracranial pressure
3. To predict neurologic outcome after a brain insult.
4. To gauge the depth of the hypnotic state of the patient under
general anesthesia
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EEG….
• International 10–20
system. Montage letters
refer to cranial location.
− C = coronal
− F = frontal
− O = occipital
− T = temporal
− Z = middle
Cont…
• The intraoperative EEG is most commonly recorded from
electrodes placed on the scalp.
• The EEG signal is described using three basic
parameters:
– Amplitude
– Frequency
– Time
• Amplitude is the size, or voltage, of the recorded signal
– It is ranges commonly from 5 to 500 μV
• EEG amplitude ↓es with age(neurons are irreversibly lost)
Cont…
• Normal patterns seen on the EEG vary among normal
individuals
• frequency in an awake patient is the beta range
(>13 Hz)
• This high frequency and usually low-amplitude signal
is common from an alert attentive brain With eye
closure, higher-amplitude signals in the alpha
frequency range (8 to 13 Hz)
– Seen best in the occipital region
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B. Sensory-evoked Responses (SERs)
• SERs are the most common type of evoked
potentials monitored intraoperatively.
• The three basic types of SERs are:
– Somatosensory evoked potentials (SSEPs)
– Brainstem auditory-evoked potentials
(BAEPs)
– Visual-evoked potentials (VEPs)
Cont…
• Physiologic factors that influence evoked
potentials:
– Temperature
– BP
– Hematocrit
– acid-base balance
– O2 and CO2 tensions
2. Brainstem Auditory-Evoked Potentials (BAEPs)
• Are the recording of brainstem responses to
auditory stimuli
• It is insensitive to both IAA and NMBDs
• To prevent (CN) VIII injury(posterior fossa
craniotomy)
– b/c of involvement of the cochlear nerve
by tumors.
Cerebral protection
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Thank you!!!
