Perioperative Uses of Transcranial Perfusion Monitoring

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1、AnesthesiologyClin25(2007)557–577PerioperativeUsesofTranscranialPerfusionMonitoringMartinSmith,MBBS,FRCADepartmentofNeuroanaesthesiaandNeurocriticalCare,TheNationalHospitalforNeurologyandNeurosurgery,UniversityCollegeLondonHospitalsNHSTrustandCentreforAnaesthesia,UniversityCollegeLondon,Box30,

2、QueenSquare,London,WC1N3BG,UKThemostimportantgoalsofneuroanesthesiaaretomaintaincerebralperfusiontomeetthetissuedemandsofoxygenandglucoseand,undercir-cumstancesofreducedperfusion,toprotectthebrain.Perioperativetrans-cranialperfusionmonitoringprovidesearlywarningofimpendingbrainischemiatosteert

3、heneurosurgeonandguidetheneuroanesthesiologisttooptimizecerebralperfusionandoxygenation.Themonitoringoptionsincludemeasurementofcerebralbloodflow(CBF),intracranialpressure(ICP),andcerebralperfusionpressure(CPP),andassessmentoftheade-quacyofperfusionbymeasurementofcerebraloxygenationandbraintiss

4、uebiochemistry.Somemonitoringtechniquesarewellestablished,whereasothersarerelativelynewtotheclinicalarenaandtheirindicationsarestillbeingevaluated(Table1).Therearefewwidelyacceptedindicationsforspecificperioperativeneu-romonitoringtechniques.Thisarticlereviewscurrentlyavailablemonitorsanddiscus

5、sestheirapplicationintheperioperativeperiod.IntracranialpressuremonitoringICPisusuallymonitoredbyanintraventricularcatheterorintraparen-chymalmicrosensor.Otheravailabletechniquesarerarelyusedandhaveasubstantiallyloweraccuracy(Table2)[1].Intraventricularcatheterspro-videthegoldstandardtechnique

6、forICPmonitoring.ThismethodmeasuresglobalICPandhastheadditionaladvantagesofallowinginvivocalibrationandtherapeuticdrainageofcerebrospinalfluid[1,2].PlacementoftheE-mailaddress:martin.smith@uclh.nhs.uk1932-2275/07/$-seefrontmatterÓ2007ElsevierInc.Allrightsreserved.doi:10.1016/j.anclin.2007.05.00

7、2anesthesiology.theclinics.com558SMITHTable1ApplicationsofneuromonitoringtechniquesEstablishedNeuroICUEstablishedperioperativeNeuromonitoringtechniqueapplicationsapplicationsIntracranialpressureYesYesQuantitativecerebralbloodflowYesResea