Zusammenfassung
Die Möglichkeit, daß ein Patient während einer Operation aus einer Allgemeinanästhesie erwacht und gar Operationsschmerz oder andere chirurgische Manipulationen wahrnehmen und postoperativ erinnern kann, muß Patienten und Anästhesisten in äußerste Beunruhigung versetzen. Es ist von daher wenig verwunderlich, daß Anästhesisten schon lange auf der Suche nach objektiven Kriterien sind, die zentrale Anästhetikaeffekte, intraoperative Wachzustände und die sogenannte Narkosetiefe anzeigen. Die wichtigsten Methoden sind: Der PRST-Score, ein Score, der aus Veränderungen autonomer vegetativer Funktionen, wie Blutdruck, Herzfrequenz, Schweißsekretion und Tränenfluß errechnet wird. Die sogenannte isolierte Unterarmtechnik, die es dem Patienten gestattet, sich während einer Narkose zu bewegen und einfachen Kommandos Folge zu leisten, auch wenn Muskelrelaxantien verwendet werden. Das spontane oder verarbeitete Elektroenzephalogramm, das die spontane neuronale Aktivität kortikaler oder kortexnaher Neuronen widerspiegelt und die akustisch evozierten Potentiale, welche die spezifische Antwort des Gehirns auf einen definierten akustischen Sinnesreiz darstellen.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsPreview
Unable to display preview. Download preview PDF.
Literatur
Russell IF. (1993) Midazolam - Alfentanil: An anaesthetic? An investigation using the isolated forearm technique. Br J Anaesth 70: 42–46
Moerman N, Bonke B, Oosting J. (1993) Awareness and recall during general anesthesia. Anesthesiology 79: 454–464
Schultetus RR, Hill CR, Dharamraj CM, Banner TE, Berman LS. (1986) Wakefulness during Cesarean section after anesthetic induction with ketamine, thiopental, or ketamine and thiopental combined. Anesth Analg 65: 723–728
Clark DL, Rosner BS. (1973) Neurophysiologic effects of general anesthetics: I. The electroencephalogram and sensory evoked responses in man. Anesthesiology V38 No. 6: 564–580
Stanski DR. (1994) Monitoring depth of anesthesia. In: Miller RD (ed) Anesthesia. 4th ed. Churchill Livingstone, New York, Edinburgh, Melbourne, pp 1127–1159
Scott JC, Ponganis KV, Stanski DR. (1985) EEG quantitation of narcotic effect: The comparative pharmacodynamics of fentanyl and alfentanil. Anesthesiology 62: 234–241
Homer TD, Stanski DR. (1985) The effect of increasing age on thiopental disposition and anesthetic requirement. Anesthesiology 62: 714–724
Chi OZ, Sommer W, Jasaitis D. (1991) Power spectral analysis of eeg during sufentanil infusion in humans. Can J Anaesth 38: 3: 275–280
Smith NT, Dec-Silver H, Sanford TJ, Westover CJ, Quinn ML, Klein F, Davis DA. (1984) EEGs during high-dose fentanyl-, sufentanil-, or morphine-oxygen anesthesia. Anesth Analg 63: 386–393
Rampil IJ, Matteo RS. (1987) Changes in EEG spectral edge frequency correlate with the hemodynamic response to laryngoscopy and intubation. Anesthesiology 67: 139–142
Schwilden H, Schüttler J, Stoeckel H. (1985) Quantitation of the eeg and pharmacodynamic modelling of hypnotic drugs: etomidate as an example. Eur J Anaesth 2: 121–131
Schwilden H, Schüttler J, Stoeckel H. (1987) Closed-loop feedback control of methohexital anesthesia by quantitative EEG analysis in humans. Anesthesiology 67: 341–347
Schwilden H, Stoeckel H. (1987) Quantitative EEG analysis during anaesthesia with isoflurane in nitrous oxide at 1.3 and 1.5 MAC. Br J Anaesth: 738–745
Hung OR, Varvel JR, Shafer SL, Stanski DR. (1992) Thiopental pharmacodynamics. II. Quantitation of clinical and electroencephalographic depth of anesthesia. Anesthesiology 77: 237–244
Drummond JC, Brann CA, Perkins DE, Wolfe DE. (1991) A comparison of median frequency, spectral edge frequency, a frequency band power ratio, total power, and dominance shift in the determination of depth of anesthesia. Acta Anaesthesiol.Scand. 35: 693–699
Dwyer R, Bennett HL, Eger II EI, Heilbron D. (1992) Effects of isoflurane and nitrous oxide in subanesthetic concentrations on memory and responsiveness in volunteers. Anesthesiology 77: 888–898
Picton TW, Hillyard SA, Krausz HI, Galambos R. (1974) Human auditory evoked potentials. I: Evaluation of components. Electroencephalogr Clin Neurophysiol 36: 179–190
Picton TW, Hillyard SA. (1974) Human auditory evoked potentials. II: Effects of attention. Electroencephalogr Clin Neurophysiol 36: 191–199
Madler C, Keller I, Schwender D, Pöppel E. (1991) Sensory information processing during general anaesthesia: Effect of Isoflurane on auditory evoked neuronal oscillations. Br J Anaesth 66: 81–87
Thornton C, Heneghan CP, James MF, Jones JG. (1984) Effects of Halothane or Enflurane with controlled ventilation on auditory evoked potentials. Br J Anaesth 56: 315–323
Abouleish E, Taylor FH. (1976) Effect of Morphine-Diazepam on signs of anesthesia, awareness, and dreams of patients under N2O for Caesarean section. Anesth Analg 55: 702–705
Thornton C, Heneghan CP, Navaratnarajah M, Jones JG. (1986) Selective effect of althesin on the auditory evoked response in man. Br J Anaesth 58: 422–427
Schwender D, Klasing S, Madler C, Pöppel E, Peter K. (1994) Mid-latency auditory evoked potentials and purposeful movements after thiopental bolus injection. Anaesthesia 49: 99–104
Newton DE, Thornton C, Konieczko KM, Jordan C, Webster NR, Luff NP, Frith CD, Dore CJ. (1992) Auditory evoked response and awareness: A study in volunteers at sub-MAC concentrations of isoflurane. Br J Anaesth 69: 122–129
Schwender D, Kaiser A, Klasing S, Peter K, Pöppel E. (1994) Mid-latency auditory evoked potentials and explicit and implicit memory in patients undergoing cardiac surgery. Anesthesiology 80: 493–501
Rights and permissions
Copyright information
© 1996 Springer-Verlag Berlin Heidelberg
About this paper
Cite this paper
Schwender, D., Daunderer, M., End, H., Kunze-Kronawitter, H., Peter, K. (1996). Praktikable Methoden zur Beurteilung der Narkosetiefe. In: Refresher Course Aktuelles Wissen für Anästhesisten. Refresher Course Aktuelles Wissen für Anästhesisten, vol 23. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-80367-3_4
Download citation
DOI: https://doi.org/10.1007/978-3-642-80367-3_4
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-540-62552-0
Online ISBN: 978-3-642-80367-3
eBook Packages: Springer Book Archive