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Cerebral Monitoring in the Operating Room and the Intensive by Enno Freye

By Enno Freye

In spite of trendy expanding physique of information in regard to valuable apprehensive func­ tion and/or the mode of motion of centrally lively compounds, little is finished to watch these sufferers that are vulnerable to cerebral lesions both within the OR or within the ICU. as a result of the inconsistency of stories concerning the software and the advantages automatic EEG and/or evoked power tracking will carry to the clinician, physicians nonetheless are reluctant to become involved with a method, which they suspect, can have very little impact at the consequence of a sufferers health. despite the fact that, because of the improvement in desktop expertise, info acquisition and comprehension, it now's attainable to watch one of these manageable organ because the significant anxious approach (CNS) on a regimen base with out being a consultant in neurology or electroencephalography. hence, the e-book is meant to steer the clinician to exploit BEG and evoked power tracking in an afternoon to day scenario, with out going too deep into technical info. As an development of cerebral care is required, a variety of consultant instances underline the translation of EEG energy spectra and evoked power adjustments in regard to the underlying medical state of affairs. it really is was hoping that this publication will function a consultant to a person who considers cerebral tracking a need in present day sufferer care. this can be the anesthesiologist, the extensive care therapist, the nurse anesthetist in addition to the scientific team of workers within the lCU setting.

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33). The change in cardiovascular parameters then provide information of the etiology of EEG slowing. Additionally, enflurane and isoflurane produce burst suppression prior to or with EEG slowing. Ischemia normally does not produce burst suppression. 5. High dose opioids may also produce an abrupt onset of EEG slowing. This would be likely to occur at the start of the case and under a situation in which question about the etiology of the EEG change is unlikely. Severe hypoxia during opioid anesthesia still produces an isoelectric EEG.

Due to deterioration of respiration she was intubated and ventilated with oxygen. Blood gas analysis now was PaO z 356 and PaCO z 42 mmHg. As intracarnial lesions still could not be ruled out and in order to evaluate cerebral activity, she was monitored with the Lifescan™ computerized EEG analyzer. EEG power spectra revealed a dominance of activity in the alpha and theta bands with little pathological delta waves (Fig. 40). As benzodiazepines in the EEG usually increase fast activity and with a suspected flunitrazepam overdose in mind, the specific benzodiazepine antagonist flumazenil (AnexateTM) was given in incremental doses.

In the EEG power spectrum, however, seizure activity is still apparent in the right hemisphere (Fig. 39). The hyperactivity is visualized in the 'glass box' derived by the Lifescan™ cerebral monitor where a fluctuation of power is reflected in the spectral edge. No such increase in spectral edge is seen in the power spectra of the left hemisphere. Insufficient anticonvulsant therapy was diagnosed and the dose increased as indicated by EEG monitoring. Thus, EEG power spectra have helped in the evaluation of sufficient dosing in that particular patient.

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