ABSTRACT
The choice of monitors in neuroanesthesia depends in large measure on the procedure and the needs of the surgeon. Monitoring is divided roughly into three areas: systemic, central nervous system, and biomarkers including laboratory studies. The transesophageal Doppler, supplying continuous real-time objective data, also monitors preload conditions and helps optimize cardiac contractility and the effect of afterload impedance on left ventricular performance. Several types of evoked potential (EP) monitoring may be used intraoperatively during both spinal and intracranial surgeries to detect ischemia and/or identify nerves, including sensory, auditory, visual, and motor. The other monitors look at electrical activity, intracranial pressure (ICP), and cerebral blood flow (CBF) and oxygen availability among other parameters. A catheter is inserted into the jugular bulb under fluoroscopic control, a far from simple maneuver. Stump pressure measures back flow after clamping of the carotid artery prior to carotid endarterectomy.
