Cerebral_monitoring_in_OR___ICU_-_Enno_Freye__2005_.pdf

Cerebral Monitoring in the OR and ICU

Edited by Enno Freye

Reprinted from Journal of Clinical Monitoring and Computing , Volume 19, Nos. 1–2, 2005

Library of Congress Cataloging-in-Publication Data

A. C.I.P. Catalogue record for this book is available from the Library of Congress

ISBN 1-4020-3162-9

Published by Springer,

P.O. Box 17, 3300 AA Dordrecht, The Netherlands.

Sold and distributed in the U.S.A. and Canada

by Springer,

101 Philip Drive, Norwell, MA 02061, U.S.A.

In all other countries, sold and distributed

by Springer,

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Printed on acid-free paper

2005 Springer

No part of the material protected by this copyright notice may be reproduced or

utilized in any form or by any means, electronic or mechanical,

including photocopying, recording or by any information storage and

retrieval system, without written permission from the copyright owner.

Printed in the Netherlands

TABLE OF CONTENTS

Preface

ENNO FREYE, MD, PhD and JOSEPH V. LEVY, PhD / Cerebral Monitoring in the Operating

Room and the Intensive Care Unit: An Introductory for the Clinician and a Guide for the Novice

Wanting to Open a Window to the Brain. Part I: The Electroencephalogram

1–76

ENNO FREYE, MD, PhD / Cerebral Monitoring in the Operating Room and the Intensive Care

Unit: An Introductory for the Clinician and a Guide for the Novice Wanting to Open a Window

to the Brain. Part II. Sensory-Evoked Potentials (SSEP, AEP, VEP)

77–168

ENNO FREYE, MD, PhD / Cerebral Monitoring in the Operating Room and the Intensive Care

Unit: An Introductory for the Clinician and a Guide for the Novice Wanting to Open a Window to

the Brain. Part III: Spinal Cord Evoked Potentials

169–178

PREFACE

etc. is not widely taught in university courses, forcing the anes-

thesiologist to embark on a disorganized study of the various

instruments, often not accompanied by an understanding of

cerebral activity. Prof. Freye’s book is an organized treatment

of cerebral activity which offers a clear explanation of the

generation of cerebral impulses and the potential value that

cerebral monitoring holds for patients. Although many com-

plex algorithms appear in the book, the text explains modern

monitoring techniques with such simplicity that even physi-

cians with little knowledge of mathematics and physics will

easily understand the subject. Moreover, the study of evoked

potentials, which is invaluable in orthopedic surgery and many

other pathologies treated in Intensive Care, is presented clearly

and logically. Attractive graphics contribute to the pleasure of

reading the book, making the subject less tiring for readers

who are confronting the subject for the ﬁrst time. Physicians

who are accustomed to using the ECG will also ﬁnd that the

close examination of this topic alone makes the book worth-

while.

The Journal of Clinical Monitoring and Computing is pleased

to present Prof. Freye’s book because it is in perfect harmony

with our publication’s goal of assisting clinicians in the daily

use of the most advanced monitoring and computer tech-

niques in patient care.

The evaluation of an ICU patient’s degree of consciousness

has taken on great importance. The problem of unintended

intraoperative rivival and compensation has resulted in the

need for monitoring the level of unconsciousness with in-

struments that measure the patient’s cerebral activity rather

than vital signs (arterial pressure, cardiac rate, tear secretion,

etc.). In addition, the need for salvaging organs for trans-

plantation requires the anesthesiologist to understand cere-

bral mechanisms to diagnose brain death before the disap-

pearance of vital signs which renders the organs useless for

transplantation. In the ﬁnal analysis the physician has had

to change his vision of cortical activity considered, if not

strictly indispensible, at least of secondary importance rela-

tive to the hemodynamic consequences to the patient. The

problem is even more complex in those nations where the

teaching of anesthesia and reanimation is combined, present-

ing the physician with the twofold chore of cerebral monitor-

ing to prevent intraoperative awakening and to detect brain

death.

Technological innovation has created simple, precise instru-

ments to replace ECG devices which are subject to artifacts

caused by patient movement or interference from other elec-

tronic instruments in the operating room or ICU. However,

the use of modern devices such as the bis-monitor, entropy,

Vincenzo Lanza

Editor-in-Chief, Journal of Clinical Monitoring and Computing

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