Reducing Perioperative Neurocognitive Disorders (PND) Through Depth of Anesthesia Monitoring: A Critical Review.
Reducing Perioperative Neurocognitive Disorders (PND) Through Depth of Anesthesia Monitoring: A Critical Review.
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通过麻醉深度监测减少围手术期神经认知障碍（PND）：一项重要综述。
DOI：
10.2147/ijgm.s242230
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发表时间：
2021
影响因子：
2.3
通讯作者：
Goldstein PA
中科院分区：
文献类型：
--
作者：
Evered LA;Goldstein PA
全身麻醉已经实施了150多年，在这段时间里，已经变得越来越安全。多项进步推动了结局的改善，包括使用无创监测器评估心血管和呼吸状态。最近的进展包括开发和使用监测器以通过“处理的”脑电图（pEEG）测量神经状态，其中通过专有算法分析额叶EEG信号以产生无量纲数（从0到100缩放），其中低值与发展到意识丧失的镇静加深水平相关。此类监护仪已被证明能够进行麻醉剂滴定，以加快苏醒和早期恢复，并提倡使用此类监护仪来预防全静脉麻醉和神经肌肉阻滞给药时的术中意识。它们的使用是否可以最大限度地减少或预防长期不良事件是一个有争议的问题。在这篇最新文献的叙述性综述中，我们评估了pEEG监测仪在预防老年患者显著且重要的术后不良结局-谵妄方面的应用。正如我们将要讨论的，现有的数据不支持其常规用于预防本人群或任何其他患者人群的术后谵妄。
General anesthesia has been administered for over 150 years, and in that time, has become progressively safer. Improvements in outcomes have been driven by multiple advances, including the use of non-invasive monitors to assess cardiovascular and respiratory status. More recent advances have included the development and use of monitors to measure neurologic status by means of “processed” electroencephalography (pEEG), wherein the frontal EEG signal is analyzed by proprietary algorithms to produce a dimensionless number (scaled from 0 to 100), wherein low values are associated with deepening levels of sedation that progresses to loss of consciousness. Such monitors have been shown to enable anesthetic titration so as to expedite emergence and early recovery, and their use is advocated for the prevention of intraoperative awareness in the setting of administration of total intravenous anesthesia and neuromuscular blockade. Whether their use can minimize, or prevent, longer term adverse events is a matter of debate. In this narrative review of the most recent literature, we provide an assessment on the use of pEEG monitors in the prevention of a notable, and important, postoperative adverse outcome – delirium – in elderly patients. As we will discuss, the existing data do not support its routine use for the prevention of postoperative delirium in this, or any other, patient population.