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Neurophysiological monitoring during intensive care and surgery

Author: N Jollyon Smith; Mark van Gils; Pamela Prior
Publisher: Edinburgh : Elsevier, ©2006.
Edition/Format:   Print book : EnglishView all editions and formats
Summary:

The principal aim of neurophysiological monitoring is to prevent damage to the nervous system. Achieving this aim places great demands on both personnel and equipment. Monitoring presents challenging  Read more...

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Document Type: Book
All Authors / Contributors: N Jollyon Smith; Mark van Gils; Pamela Prior
ISBN: 072343381X 9780723433811
OCLC Number: 70788595
Description: xvii, 390 pages : illustrations (some color) ; 28 cm
Contents: Contributors, v; Foreword, vii; Preface, ix; Dedication, x; Acknowledgements, x; Abbreviations, xi; 1 The why and the how of neurophysiological monitoring in the ICU and surgery, 1; Introduction, 1; Applications of clinical neurophysiology in the ICU, 1; Monitoring during surgical operations, 3; Assessment of results, 7; Statistical significance of changes, 7; Clinical significance of changes, 8; Confidence intervals, 10; Determining the optimal cut-off point, 11; Comparing two methods of monitoring, 11; The effect of corrective action, 12; Is the risk eliminated by monitoring?, 13; References, 14; 2 Neurophysiological instrumentation, connection with patients and recording methods, 17; Introduction, 17; Recording the electrical activities of the nervous system, 18; Electrodes for neurophysiological recording, 18; Electrode placement systems, 24; Connecting electrodes to amplifiers and the recording convention, 29; Amplifiers, 32; Signal bandwidth and filters, 35; Digital systems, 37; EEG recording equipment, 38; General features of EEG machines, 38; Input circuits for EEG recording, 39; Amplifiers for EEG recording, 39; Filters for EEG recording, 40; Analogue EEG systems, 40; Digital EEG systems, 42; Evoked potential recording systems, 48; Electrodes for EP recording, 48; Amplifiers for EP recording, 48; Filters for EP recording, 48; Averaging, 48; EP display, 49; Calibration of EP recorders, 49; EP stimulators, 49; EMG and nerve conduction studies, 53; Electrodes for EMG and nerve conduction studies, 53; Amplifiers for EMG and nerve conduction, 54; Displaying EMG and nerve conduction data, 55; Stimulation for nerve conduction studies, 55; Practical aspects of intraoperative and ICU neurophysiological recording, 55; Safety during neurophysiological recording in the ICU and operating theatres, 55; Intraoperative and ICU EEG recording, 59; Intraoperative and ICU EP recording, 65; EMG and nerve conduction studies, 68; References, 68; 3 Introduction to methods for continuous EEG and evoked potential monitoring, 73; Introduction, 73; EEG monitoring, 73; Historical development of EEG monitors, 73; Technical requirements for EEG monitoring in the ICU and during surgical operations, 85; Evoked potential monitoring, 94; Technical requirements for EP monitoring, 94; Comparisons between currently used methods, 100; Conclusions, 102; References, 103. 4 Normal and pathological phenomena in EEG, evoked potential, EMG and nerve conduction studies, 109; General introduction, 109; EEG WAVEFORMS AND INTERPRETATION, 109; Introduction, 109; Describing EEG phenomena, 109; Wave shape (morphology), 110; Rhythmicity, 110; Frequency of repetition, 110; Amplitude, 110; Transients, 112; Spatial distribution, 113; Spatiotemporal patterns, 113; Symmetry and synchrony, 113; Inherent variability of the EEG and other biological rhythms, 113; Reactivity, 114; General categories of abnormality in the EEG of importance for ICU and intraoperative monitoring, 114; Change in frequency content, 114; Amplitude reduction, 115; Localized and lateralized abnormalities, 116; Rhythms at a distance (projected rhythms), 117; Altered reactivity, 118; Epileptiform activity, 119; Periodicity, 120; Burst suppression pattern, 123; Electrocerebral inactivity - electrocerebral silence (ECS) - the isoelectric EEG, 124; EVOKED POTENTIAL WAVEFORMS AND INTERPRETATION, 125; General definition - limitations - clinical utility of evoked potentials, 125; Responses and EP components, 126; The electroretinogram and electrocochleogram, 126; Relation between neuronal responses and surface evoked potentials, 127; Action potentials, 127; Postsynaptic potentials, 128; Near-field versus far-field evoked potentials, 128; How to localize evoked potential sources from surface recordings, 130; Normal findings by modality, 131; Flash VEPs, 131; Auditory evoked potentials: BAEPs and MLAEPs, 132; Somatosensory evoked potentials, 134; EMG FINDINGS AND INTERPRETATION, 145; Features of motor units recorded by needle electrodes, 145; Other normal EEG phenomena, 145; Insertion activity, 145; End-plate noise, 145; Fibrillations at single sites, 146; Fasciculations, 146; Nerve conduction, 147; Effects of limb temperature on nerve conduction, 147; References, 148; 5 Neurophysiological monitoring during sedation and anaesthesia, 155; Introduction, 155; Sedation: assessment with EEG and evoked potentials, 155; Effects of sedative drugs on the EEG, 155; Effects of sedative drugs on EPs, 157; Assessment of sedation, 159; Anaesthesia: assessment with EEG and evoked potentials, 161; Effect of anaesthetic agents on the EEG, 161; Effect of anaesthetic agents on EPs, 172; Combined EEG and evoked potential measures, 176; Awareness during anaesthesia, 176; Neurophysiological features useful in prediction of possible awareness during anaesthesia, 177; Medico-legal aspects of awareness during anaesthesia, 180; References, 182; 6 Neurophysiological work in the ICU, 189; Introduction, 189; Neurophysiological parameters to be monitored and procedures, 189; Sleep in the ICU, 189; CLINICAL CONDITIONS AFFECTING THE CENTRAL NERVOUS SYSTEM ENCOUNTERED IN ICU, 189; Coma and related states, 189; EEG recording and interpretation in coma and related states, 189; EPs in comatose patients, 199; EPs combined with other variables, 215; Cardiac arrest and hypoxic - ischaemic encephalopathies, 216; Other metabolic and toxic encephalopathies and multiple organ failure, 218; Encephalitis, 218; Epileptiform discharges and status epilepticus, 218; Head injury and other neurosurgical applications, 221. Vegetative states and brainstem death (brain death), 225; Vegetative states, 225; Brainstem death (brain death), 228; CLINICAL CONDITIONS AFFECTING THE PERIPHERAL NERVOUS SYSTEM AND MUSCLES ENCOUNTERED IN THE ICU, 231; Neuromuscular syndromes of critical illness (critical illness neuropathy), 231; Acute onset neuropathies, 234; Guillain - Barre syndrome (GBS), 234; Acute intermittent porphyria, 237; Other causes of acute or subacute peripheral neuropathy, 242; Acute weakness due to disorders of neuromuscular transmission, 242; Botulism, 242; Myasthenia gravis, 242; Familial periodic paralysis and the channelopathies, 242; Non-peripheral causes of acute onset generalized weakness, 243; References, 243; 7 Neurophysiological monitoring during surgical operations, 253; Introduction, 253; Intracranial surgery, 253; EEG monitoring in intracranial surgery, 253; Visual evoked potential monitoring, 256; SEP monitoring in intracranial surgery, 257; Posterior fossa surgery, 260; Spinal cord function monitoring, 268; Experimental studies and mechanisms of spinal cord damage, 268; Methods of monitoring cord function, 269; Practical aspects of spinal cord monitoring, 272; Clinical applications of spinal cord monitoring, 274; Spinal root surgery and peripheral nerve surgery, 278; Cerebral ischaemia during non-intracranial surgery, 279; Cardiac surgery, 279; Carotid endarterectomy, 285; References, 292; 8 Further signal analysis, 309; Introduction, 309; Data acquisition, 311; Technology, 311; Safety issues, 315; Improving signal quality, 317; Filtering methods, 318; Artefact detection and rejection methods, 327; Signal processing and interpretation, 327; Common processing tasks, 329; Processing methods, 332; Integration of features into the clinical context - pattern classification, 346; Statistical process control, 354; Use of the tools, 358; Decision assistance, 358; Development and uptake of methods, 359; Performance assessment, 359; Display of results, 360; Use of IT facilities, 363; References, 365; 9 Legal implications of neurophysiological monitoring, 371; Safety of patients and staff, 371; Electromedical equipment, 372; Infection control, 373; Drugs, 373; Identification of patients and consent to procedures, 373; Inherent risk of procedures, 374; Responsibilities in training and supervising staff, 374; Responsibilities in respect of reports on investigations, 375; References, 375; Index, 377.
Responsibility: edited by N. Jollyon Smith, Mark van Gils, Pamela Prior ; foreword by Arvi Yli-Hankala.

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This book should find a place in libraries of intensive care medicine, neurology, neurological surgery, neurophysiology, anesthesia and biomedicine. Clinical Neurophysiology When the reader is left Read more...

 
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