脊柱手術(shù)的麻醉ppt課件-在線瀏覽
2025-02-22 17:40本頁面
【正文】 recordings throughout surgery, but to have a paraplegic patient postoperatively. ? Satisfactory monitoring of early cortical SSEPs is possible with – MAC isoflurane, desflurane and sevoflurane. ? Nitrous oxide potentiates the depressant effect of volatile anesthetics ? Intravenous anesthetics generally affect SSEPs less than inhaled anesthetics ? Etomidate and ketamine increases cortical SSEP amplitude ? Clinically unimportant changes in SSEP latency and amplitude after the administration of opioids 麻醉藥和 SSEPs SSEPs 監(jiān)測(cè)意義 ? Eliminating N2O from the background anesthetic has been shown to improve cortical amplitude sufficiently to make monitoring more reliable ? SSEP latency will take 5–8 min to stabilize after the step changes in volatile anesthetic concentration ? Adding etomidate, propofol or opioids is preferable to beginning N2O or increasing volatile anesthetic concentrations when anesthetic depth is inadequate ? If a volatile anesthetic is nevertheless needed rapidly, sevoflurane permits faster SSEP recovery after the acute need for volatile anesthetic has been resolved ? It is critical to avoid sudden changes in volatile anesthetic depth or bolus administration of intravenous anesthetics during surgical manipulations that could jeopardize the integrity of the neural pathways being monitored MEPs Motor cortex stimulated by electrical or magic means Myogenic responses Neurogenic responses: peripheral N or spinal cord 麻醉藥和 MEPs ? Inhalational anesthetics suppress myogenic MEPs in a dosedependent manner ? Paired pulses or a train of pulses cannot overe the suppressive effects ? Should be avoided, or limited to a very low concentration during the monitoring of myogenic MEPs ? N2O appears to be less suppressive than other inhaled agents. Moderate doses of up to 50% N20 have been used successfully to supplement other agents during myogenic MEP monitoring. ? Fentanyl, etomidate, and ketamine have little or no effect on myogenic MEP and are patible with intraoperative recording. ? Benzodiazepines, barbiturates, and propofol also produce m
教學(xué)課件相關(guān)推薦
鄂ICP備17016276號(hào)-1