Anästhesiol Intensivmed Notfallmed Schmerzther 2004; 39(1): 33-63
DOI: 10.1055/s-2004-815708
Fort- und Weiterbildung
© Georg Thieme Verlag Stuttgart · New York

Neuromonitoring für die Abschätzung der Narkosetiefe

Neuromonitoring for Estimating the Depth of NarcosisG.  N.  Schmidt1 , P.  Bischoff1
  • 1Zentrum für Anästhesiologie Klinik und Poliklinik für Anästhesiologie (Direktor: Prof. Dr. med. Dr. h.c. Schulte am Esch) Universitätsklinikum Hamburg-Eppendorf
Further Information

Publication History

Publication Date:
19 January 2004 (online)

Weiterbildungsziele

In diesem Beitrag sollen folgende Weiterbildungsziele vermittelt werden:

  • Darstellung und Definition der Narkosetiefe

  • Formen und Folgen von intraoperativer Wachheit

  • Anforderungen an Narkosetiefe-Monitore und deren statistische Evaluierung

  • Grundlagen des Elektroenzephalogramms und evozierter Potenziale

  • Überblick über die derzeit kommerziell verfügbaren Monitorsysteme

Literatur

  • 1 Lehmann A, Thaler E, Boldt J. Is measuring the depth of anesthesia sensible? An overview on the currently available monitoring systems.  Anasthesiol Intensivmed Notfallmed Schmerzther. 2001;  36 683-692
  • 2 Kochs E, Schneider G. Monitoring depth of anaesthesia: possible or not?.  Anasthesiol Intensivmed Notfallmed Schmerzther. 2001;  36 661-663
  • 3 Schwarz. Hirnstrommuster unter Anästhetikaeinfluss. Wiesbaden; Wiss. Verl.-Abt. Abott GmbH 1998
  • 4 Schneider G, Gelb A W, Schmeller B, Tschakert R, Kochs E. Detection of awareness in surgical patients with EEG-based indices - bispectral index and patient state index.  Br J Anaesth. 2003;  91 329-335
  • 5 Brice D D, Hetherington R R, Utting J E. A simple study of awareness and dreaming during anaesthesia.  Br J Anaesth. 1970;  42 535-542
  • 6 Schneider G, Gelb A W, Schmeller B, Tschakert R, Kochs E. Detection of awareness in surgical patients with EEG-based indices-bispectral index and patient state index.  Br J Anaesth. 2003;  91 329-335
  • 7 Schwender D, Kaiser A, Klasing S, Faber-Zullig E, Golling W, Poppel E, Peter K. Anesthesia with flunitrazepam/fentanyl and isoflurane/fentanyl. Unconscious perception and mid-latency auditory evoked potentials.  Anaesthesist. 1994;  43 289-297
  • 8 Meyer B, Blacher R. A traumatic neurotic reaction induced by succinylcholine chloride.  N Z Med J. 1961;  61 1255-1261
  • 9 Evans C, Richardson P. Improved recovery and reduced postoperative stay after therapeutic suggestionsduring general anaesthesia.  Lancet. 1988;  2 491-493
  • 10 Evans J M. Clinical signs and automatic responses. London; Butterworth 1987
  • 11 Russell I F. Isolated forearm technique.  Anaesthesia. 1990;  45 687-688
  • 12 Cogliolo P, Tufano R, Romano V, Villani R, Duvall M, Laurino S, Del F ranco, Coppola T. Anesthesia, awareness and wakefulness.  Minerva Anestesiol. 1990;  56 161-163
  • 13 Domino K B, Posner K L, Caplan R A, Cheney F W. Awareness during anesthesia: a closed claims analysis.  Anesthesiology. 1999;  90 1053-1061
  • 14 Drummond J C. Monitoring depth of anesthesia: with emphasis on the application of the bispectral index and the middle latency auditory evoked response to the prevention of recall.  Anesthesiology. 2000;  93 876-882
  • 15 Sebel P. Can we monitor depth of anesthesia?.  Anesth Analg. 2001;  92 (Suppl) S94-S98
  • 16 Smith W D, Dutton R C, Smith N T. Measuring the performance of anesthetic depth indicators.  Anesthesiology. 1996;  84 38-51
  • 17 Tosteson A N, Weinstein M C, Wittenberg J, Begg C B. ROC curve regression analysis: the use of ordinal regression models for diagnostic test assessment.  Environ Health Perspect. 1994;  102 (Suppl 8) S73-S78
  • 18 Zschocke S. Auswertung und Beschreibung des EEG. Heidelberg; Springer 2002
  • 19 Priestley M. Spectral Analysis and Time Series. London; Academic Press 1981
  • 20 Schwilden H, Schuttler J, Stoeckel H. Closed-loop feedback control of methohexital anesthesia by quantitative EEG analysis in humans.  Anesthesiology. 1987;  67 341-347
  • 21 Gurman G M. Assessment of depth of general anesthesia. Observations on processed EEG and spectral edge frequency.  Int J Clin Monit Comput. 1994;  11 185-189
  • 22 Bruhn J. Vergleich verschiedener EEG-Parameter: Spektrale Eckfrequenz 95, approximate Entropie und Bispektral-Index.  Anästhesiologie & Intensivmedizin. 2003;  44 17-21
  • 23 Kochs E. Überwachung der Hirnfunktion. Berlin; Springer 1995
  • 24 Thornton C. Evoked potentials in anaesthesia.  Eur J Anaesthesiol. 1991;  8 89-107
  • 25 Doi M, Gajraj R J, Mantzaridis H, Kenny G N. Relationship between calculated blood concentration of propofol and electrophysiological variables during emergence from anaesthesia: comparison of bispectral index, spectral edge frequency, median frequency and auditory evoked potential index.  Br J Anaesth. 1997;  78 180-184
  • 26 Mantzaridis H, Kenny G N. Auditory evoked potential index: a quantitative measure of changes in auditory evoked potentials during general anaesthesia.  Anaesthesia. 1997;  52 1030-1036
  • 27 Jensen E W, Lindholm P, Henneberg S W. Autoregressive modeling with exogenous input of middle-latency auditory-evoked potentials to measure rapid changes in depth of anesthesia.  Methods Inf Med. 1996;  35 256-260
  • 28 Banoub M, Tetzlaff J E, Schubert A. Pharmacologic and physiologic influences affecting sensory evoked potentials: implications for perioperative monitoring.  Anesthesiology. 2003;  99 716-737
  • 29 O’Connor M F, Daves S M, Tung A, Cook R I, Thisted R, Apfelbaum J. BIS monitoring to prevent awareness during general anesthesia.  Anesthesiology. 2001;  94 520-522
  • 30 Rampil I J. A primer for EEG signal processing in anesthesia.  Anesthesiology. 1998;  89 980-1002
  • 31 Katoh T, Suzuki A, Ikeda K. Electroencephalographic derivatives as a tool for predicting the depth of sedation and anesthesia induced by sevoflurane.  Anesthesiology. 1998;  88 642-650
  • 32 Glass P S, Bloom M, Kearse L, Rosow C, Sebel P, Manberg P. Bispectral analysis measures sedation and memory effects of propofol, midazolam, isoflurane, and alfentanil in healthy volunteers.  Anesthesiology. 1997;  86 836-847
  • 33 Song D, Joshi G P, White P F. Titration of volatile anesthetics using bispectral index facilitates recovery after ambulatory anesthesia.  Anesthesiology. 1997;  87 842-848
  • 34 Schmidt G N, Bischoff P, Standl T, Lankenau G, Hellsten A, Hipp C, Schulte a m. SNAP Index and Bispectral Index during different states of propofol/remifentanil anaesthesia. Anaesthesia im Druck
  • 35 Messner M, Beese U, Romstock J, Dinkel M, Tschaikowsky K. The bispectral index declines during neuromuscular block in fully awake persons.  Anesth Analg. 2003;  97 488-491
  • 36 Detsch O, Schneider G, Kochs E, Hapfelmeier G, Werner C. Increasing isoflurane concentration may cause paradoxical increases in the EEG bispectral index in surgical patients.  Br J Anaesth. 2000;  84 33-37
  • 37 Jeleazcov C, Schwilden H. Die Häufigkeit nicht-trivialer EEG-Bispektra während Isofluran/Alfentanil-Narkosen ist kleiner als 5 %.  Anästhesiologie & Intensivmedizin. 2001;  42 509
  • 38 Guignard B, Menigaux C, Dupont X, Fletcher D, Chauvin M. The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation.  Anesth Analg. 2000;  90 161-167
  • 39 Mychaskiw G, Horowitz M, Sachdev V, Heath B J. Explicit intraoperative recall at a Bispectral Index of 47.  Anesth Analg. 2001;  92 808-809
  • 40 Song D, van Vlymen J, White P F. Is the bispectral index useful in predicting fast-track eligibility after ambulatory anesthesia with propofol and desflurane?.  Anesth Analg. 1998;  87 1245- 1248
  • 41 Ahmad S, Yilmaz M, Marcus R, Glisson S, Kinsella A. Impact of bispectral index monitoring on fast tracking of gynecologic patients undergoing laparoscopic surgery.  Anesthesiology. 2003;  98 849-852
  • 42 Loomis A, Harvey E, Hobart C. Cerebral states during sleep as studied by human brain potentials.  J Exp Psychol. 1937;  21 127-144
  • 43 Kugler J. Elektroenzephalographie in Klinik und Praxis. Stuttgart, New York; Thieme 1981
  • 44 Schultz B, Grouven U, Schultz A. Automatic classification algorithms of the EEG monitor Narcotrend for routinely recorded EEG data from general anaesthesia: a validation study.  Biomed Tech (Berl). 2002;  47 9-13
  • 45 Kreuer S, Biedler A, Larsen R, Altmann S, Wilhelm W. Narcotrend monitoring allows faster emergence and a reduction of drug consumption in propofol-remifentanil anesthesia.  Anesthesiology. 2003;  99 34-41
  • 46 Kreuer S, Biedler A, Larsen R, Schoth S, Altmann S, Wilhelm W. The Narcotrend - a new EEG monitor designed to measure the depth of anaesthesia. A comparison with bispectral index monitoring during propofol-remifentanil-anaesthesia.  Anaesthesist. 2001;  50 921-925
  • 47 Schmidt G N, Bischoff P, Standl T, Voigt M, Papavero L, Schulte a m. Narcotrend, bispectral index, and classical electroencephalogram variables during emergence from propofol/remifentanil anesthesia.  Anesth Analg. 2002;  95 1324-1330
  • 48 Kreuer S, Molter G, Biedler A, Larsen R, Schoth S, Wilhelm W. Narcotrend stages and end-tidal desflurane concentrations. An investigation during recovery from desflurane/remifentanil anaesthesia.  Anaesthesist. 2002;  51 800-804
  • 49 Schmidt G N, Bischoff P, Standl T, Jensen K, Voigt M, Schulte am Esch J. Narcotrend and Bispectral Index monitor are superior to classic electroencephalographic parameters for the assessment of anesthetic states during propofol-remifentanil anesthesia.  Anesthesiology. 2003;  99 1072-1077
  • 50 Schmidt G N, Bischoff P, Standl T, Lankenau G, Hilbert M, Schulte am Esch J. Comparative evaluation of Narcotrend, BIS and classical EEG parameters during induction, maintenance and emergence of a propofol/remifentanil anesthesia. Anesth Analg 2004: im Druck
  • 51 Munte S, Munte T F, Grotkamp J, Haeseler G, Raymondos K, Piepenbrock S, Kraus G. Implicit memory varies as a function of hypnotic electroencephalogram stage in surgical patients.  Anesth Analg. 2003;  97 132-138
  • 52 Wilhelm W, Kreuer S, Larsen R. Narcotrend EEG monitoring during total intravenous anaesthesia in 4.630 patients.  Anaesthesist. 2002;  51 980-988
  • 53 Bischoff P, Standl T, Schmidt G. Monitoring of the ellectroencephalogram should not provide risks of intraoperative memory because of aspired faster emergence and reduction of drug consumptions. Anesthesiology im Druck
  • 54 Litvan H, Jensen E W, Galan J, Lund J, Rodriguez B E, Henneberg S W, Caminal P, Villar L andeira. Comparison of conventional averaged and rapid averaged, autoregressive-based extracted auditory evoked potentials for monitoring the hypnotic level during propofol induction.  Anesthesiology. 2002;  97 351-358
  • 55 Litvan H, Jensen E W, Revuelta M, Henneberg S W, Paniagua P, Campos J M, Martinez P, Caminal P, Villar L andeira. Comparison of auditory evoked potentials and the A-line ARX Index for monitoring the hypnotic level during sevoflurane and propofol induction.  Acta Anaesthesiol Scand. 2002;  46 245-251
  • 56 Alpiger S, Helbo-Hansen H S, Jensen E W. Effect of sevoflurane on the mid-latency auditory evoked potentials measured by a new fast extracting monitor.  Acta Anaesthesiol Scand. 2002;  46 252-256
  • 57 Struys M MRF, Jensen E W, Smith W, Smith N T, Rampil I, Dumortier F JE, Mestach C, Mortier E P. Performance of the ARX-derived auditory evoked potential index as an indicator of anesthetic depth: a comparison with bispectral index and hemodynamic measures during propofol administration.  Anesthesiology. 2002;  96 803-816
  • 58 Schmidt G N, Bischoff P, Standl T, Issleib M, Voigt M, Schulte am Esch J. ARX-derived auditory evoked potential index and bispectral index during the induction of anesthesia with propofol and remifentanil.  Anesth Analg. 2003;  97 139-144
  • 59 Barr G, Anderson R E, Jakobsson J G. A study of bispectral analysis and auditory evoked potential indices during propofol-induced hypnosis in volunteers: the effect of an episode of wakefulness on explicit and implicit memory.  Anaesthesia. 2001;  56 888-893
  • 60 Kreuer S, Bruhn J, Larsen R, Hoepstein M, Wilhelm W. Comparison of Alaris AEP index and bispectral index during propofol-remifentanil anaesthesia.  Br J Anaesth. 2003;  91 336-340
  • 61 Bischoff P, Schmidt G unter . Akustisch evozierte Potentiale: Grundlagen, Indexberechnungen und klinische Erfahrungen.  Anästhesiologie & Intensivmedizin. 2003;  44 27-30
  • 62 Schmidt G N, Bischoff P, Standl T, Lankenau G, Schulte am Esch J. Alaris AEP monitor’s „Click Detection” does not help to detect inadvertent disconnection of headphones during anesthesia.  Anesth Analg. 2004;  98 123-127
  • 63 Schwender D, Kunze-Kronawitter H, Dietrich P, Klasing S, Forst H, Madler C. Conscious awareness during general anaesthesia: patients’ perceptions, emotions, cognition and reactions.  Br J Anaesth. 1998;  80 133-139
  • 64 Recart A, White P F, Wang A, Gasanova I, Byerly S, Jones S B. Effect of auditory evoked potential index monitoring on anesthetic drug requirements and recovery profile after laparoscopic surgery: a clinical utility study.  Anesthesiology. 2003;  99 813-818
  • 65 Kochs E, Bischoff P, Pichlmeier U, Schulte a m. Surgical stimulation induces changes in brain electrical activity during isoflurane/nitrous oxide anesthesia. A topographic electroencephalographic analysis.  Anesthesiology. 1994;  80 1026-1034
  • 66 Bischoff P, Scharein E, Schmidt G N, von Knobelsdorff G, Bromm B, Schulte am Esch J. Topography of clonidine-induced electroencephalographic changes evaluated by principal component analysis.  Anesthesiology. 2000;  92 1545-1552
  • 67 Sleigh J W, Steyn-Ross D A, Steyn-Ross M L, Williams M L, Smith P. Comparison of changes in electroencephalographic measures during induction of general anaesthesia: influence of the gamma frequency band and electromyogram signal.  Br J Anaesth. 2001;  86 50-58
  • 68 Bruhn J, Bouillon T W, Shafer S L. Electromyographic activity falsely elevates the bispectral index.  Anesthesiology. 2000;  92 1485-1487
  • 69 Schmidt G N, Bischoff P, Standl T, Lankenau G, Hellstern A, Hipp C, Schulte a m. SNAP Index und Bispectral Index während Narkoseeinleitung mit Propofol und Remifentanil. Anästhesiol Intensivmed Notfallmed Schmerzther 2004: im Druck
  • 70 Bruhn J, Lehmann L E, Ropcke H, Bouillon T W, Hoeft A. Shannon entropy applied to the measurement of the electroencephalographic effects of desflurane.  Anesthesiology. 2001;  95 30-35
  • 71 Bruhn J, Ropcke H, Hoeft A. Approximate entropy as an electroencephalographic measure of anesthetic drug effect during desflurane anesthesia.  Anesthesiology. 2000;  92 715-726
  • 72 Bruhn J, Bouillon T W, Radulescu L, Hoeft A, Bertaccini E, Shafer S L. Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of „anesthetic depth” during coadministration of propofol and remifentanil.  Anesthesiology. 2003;  98 621-627
  • 73 Drover D R, Lemmens H J, Pierce E T, Plourde G, Loyd G, Ornstein E, Prichep L S, Chabot R J, Gugino L. Patient State Index: titration of delivery and recovery from propofol, alfentanil, and nitrous oxide anesthesia.  Anesthesiology. 2002;  97 82-89
  • 74 Chen X, Tang J, White P F, Wender R H, Ma H, Sloninsky A, Kariger R. A comparison of patient state index and bispectral index values during the perioperative period.  Anesth Analg. 2002;  95 1669-1674

Dr. med. Gunter N. Schmidt

Zentrum für Anästhesiologie Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf

Martinistrasse 52

20246 Hamburg

Email: guschmid@uke.uni-hamburg.de

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