Practical Use of the Raw Electroencephalogram Waveform During General Anesthesia: The Art and Science
Practical Use of the Raw Electroencephalogram Waveform During General Anesthesia: The Art and Science
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DOI：
10.1213/ane.0b013e3181a9fc38
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发表时间：
2009-08-01
影响因子：
5.7
通讯作者：
Sleigh, James W.
中科院分区：
文献类型：
--
作者：
Bennett, Cambell;Voss, Logan J.;Sleigh, James W.
定量脑电图（qEEG）监测仪通常用于全身麻醉期间估计麻醉深度和术中回忆。与任何监护仪一样，处理后的数字输出通常会产生误导，必须在临床背景下进行解释。为了这些监护仪的安全临床使用，对预期的原始脑电图（EEG）模式的清晰的心理图像以及对常见EEG伪影的了解是绝对必要的。这就是编写本教程的动机。我们描述，并给出例子，典型的脑电图特征，充分的全身麻醉，伤害性刺激的影响，和预防性药物。伪影是常见的，可分为头部外、头部但脑外（通常为额肌电）或脑内（非典型或病理性）。我们包括临床问题解决过程的真实的例子。特别是，重要的是要认识到，人为的高qEEG指数是相对常见的，并可能导致危险的麻醉药物过量。麻醉师必须确定qEEG数与患者的表观状态、各种麻醉药物的剂量和手术刺激的程度一致，并且qEEG数与原始EEG信号的外观一致。任何差异都必须是一种刺激，促使我们利用所有可用的信息，而不是反应性治疗来“治疗”一个数字，立即对患者的状态进行关键检查。（Anesth Analg 2009;109：539-50）
Quantitative electroencephalogram (qEEG) monitors are often used to estimate depth of anesthesia and intraoperative recall during general anesthesia. As with any monitor, the processed numerical Output is often misleading and has to be interpreted within a clinical context. For the safe clinical use of these monitors, a clear mental Picture of the expected raw electroencephalogram (EEG) patterns, as well as a knowledge of the common EEG artifacts, is absolutely necessary. This has provided the motivation to write this tutorial. We describe, and give examples of, the typical EEG features of adequate general anesthesia, effects of noxious stimulation, and adjunctive drugs. Artifacts are commonly encountered and may be classified as arising from outside the head, from the head but outside the brain (commonly frontal electromyogram), or from within the brain (atypical or pathologic). We include real examples of clinical problem-solving processes. In particular, it is important to realize that an artifactually high qEEG index is relatively common and may result in dangerous anesthetic drug Overdose. The anesthesiologist must be certain that the qEEG number is consistent with the apparent state of the patient, the doses of various anesthetic drugs, and the degree of surgical stimulation, and that the qEEG number is consistent with the appearance of the raw EEG signal. Any discrepancy must be a stimulus for the immediate critical examination of the patient's state using all the available information rather than reactive therapy to "treat" a number. (Anesth Analg 2009;109:539-50)