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Intraoperatives elektrophysiologisches Monitoring mit evozierten Potenzialen

Intraoperative electrophysiological monitoring with evoked potentials

  • Allgemeinanästhesie
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Zusammenfassung

Das intraoperative elektrophysiologische Monitoring (IOEM) hat seit über 30 Jahren zunehmende Bedeutung erlangt, um die Funktion von neuronalen Strukturen zu überwachen und operative Folgeschäden zu vermeiden. Durch die Verwendung von IOEM konnte die Inzidenz postoperativer neurologischer Defizite nach vielen Eingriffen gesenkt werden. Motorisch evozierte Potenziale (MEP) scheinen hierbei anderen Verfahren in vielen Einsatzbereichen bei der Überwachung des zentralen Nervensystems überlegen zu sein. Während der Anwendung von IOEM sollte die Allgemeinanästhesie opioidbetont und als totale intravenöse Anästhesie mit Propofol durchgeführt werden. Abhängig davon, ob eine MEP- oder Elektromyogrammableitung geplant ist, muss auf eine Muskelrelaxierung entweder verzichtet oder in einem titrierten Dosisbereich ein stabiler Relaxierungszustand beibehalten werden. Das IOEM wird von Chirurgen, Neurologen, Neurophysiologen oder zunehmend auch von Anästhesisten durchgeführt. Für die sichere Anwendung und Interpretation sind Kenntnisse über die Auswirkungen des chirurgischen Eingriffs sowie die pharmakologischen und physiologischen Einflüsse auf die abgeleiteten elektrischen Potenziale essenziell.

Abstract

During the last 30 years intraoperative electrophysiological monitoring (IOEM) has gained increasing importance in monitoring the function of neuronal structures and the intraoperative detection of impending new neurological deficits. The use of IOEM could reduce the incidence of postoperative neurological deficits after various surgical procedures. Motor evoked potentials (MEP) seem to be superior to other methods for many indications regarding monitoring of the central nervous system. During the application of IOEM general anesthesia should be provided by total intravenous anesthesia with propofol with an emphasis on a continuous high opioid dosage. When intraoperative MEP or electromyography guidance is planned, muscle relaxation must be either completely omitted or maintained in a titrated dose range in a steady state. The IOEM can be performed by surgeons, neurologists and neurophysiologists or increasingly more by anesthesiologists. However, to guarantee a safe application and interpretation, sufficient knowledge of the effects of the surgical procedure and pharmacological and physiological influences on the neurophysiological findings are indispensable.

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Der korrespondierende Autor weist für sich auf folgende Beziehung hin: Reisekostenübernahme durch die Fa. Inomed, Emmendingen, Deutschland. Alle anderen Autoren: keine Interessenkonflikte.

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  1. Klinik und Poliklinik für Anästhesiologie, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland

    R. Nitzschke, A.E. Goetz & M.S. Goepfert

  2. Orthopädische Wirbelsäulenchirurgie Spine Center, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    N. Hansen-Algenstaedt

  3. Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    J. Regelsberger

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  1. R. Nitzschke
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Nitzschke, R., Hansen-Algenstaedt, N., Regelsberger, J. et al. Intraoperatives elektrophysiologisches Monitoring mit evozierten Potenzialen. Anaesthesist 61, 320–335 (2012). https://doi.org/10.1007/s00101-012-2015-3

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