Chapter 38
- Neurologic Monitoring
- Michael E. Mahla
- Susan Black
- Roy F. Cucchiara
In the 21st century, surgeons are attempting progressively more
complex procedures involving the substance, supporting structures, and blood supply
of the central and peripheral nervous systems. Direct, timely feedback about the
effects of surgery on nervous system function and the adequacy of its blood supply
can be extremely valuable to the surgeon. The best monitor of neurologic function
remains the awake patient. In the awake patient, function of individual parts of
the nervous system and the complex, often poorly understood interactions of different
portions of the nervous system can be readily assessed. However, most surgical procedures
involving the nervous system or its blood supply require general anesthesia. Current
technology limits us to assessments of adequacy of blood flow to portions of the
nervous system and the electrical function of groups of neurons and nervous system
pathways that are not excessively depressed by the presence of anesthetic drugs.
This chapter focuses on monitoring nervous system electrical function
and the adequacy of its blood supply using instruments also commonly used in the
diagnostic laboratory. Types of operations in which neurologic monitoring has been
used effectively are reviewed, and some of the changes that occur acutely in the
operating room are described. Howe these signals are altered by commonly used anesthetics
is reviewed in detail, and evidence for the utility and efficacy of neurologic monitoring
is examined.
