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Neuromonitoring in the ambulatory anesthesia setting

a pro–con discussion

Grosland, Jeffrey O.a; Todd, Michael M.a; Goldstein, Peter A.b,c

Current Opinion in Anesthesiology: December 2018 - Volume 31 - Issue 6 - p 667–672
doi: 10.1097/ACO.0000000000000654
AMBULATORY ANESTHESIA: Edited by Claude Meistelman
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Purpose of review Various neurologically focused monitoring modalities such as processed electroencephalography (pEEG), tissue/brain oxygenation monitors (SbO2), and even somatosensory evoked responses have been suggested as having the potential to improve the well tolerated and effective delivery of care in the setting of outpatient surgery. The present article will discuss the pros and cons of such monitors in this environment.

Recent findings There is a paucity of evidence from rigorous, well designed clinical trials demonstrating that the routine use of any neuromonitoring technique in an ambulatory surgery setting leads to meaningful cost savings or a reduction in morbidity or mortality.

Summary The use of advanced neuromonitoring techniques (primarily pEEG) may be considered reasonable in two instances: for the prevention of intraoperative awareness during the administration of total intravenous anesthesia coupled with the use of a neuromuscular blocking drug, and for the prevention of relative drug overdose (and possibly postoperative delirium) in the elderly.

aDepartment of Anesthesiology, University of Minnesota School of Medicine, Minneapolis, Minnesota

bDepartment of Anesthesiology

cDepartment of Medicine, Weill Cornell Medicine, New York, New York, USA

Correspondence to Peter A. Goldstein, MD, C.V. Starr Laboratory for Molecular Neuropharmacology, Department of Anesthesiology, Weill Cornell Medicine, 1300 York Avenue, Room A-1050, New York, NY 10065, USA. Tel: +1 212 746 5325; fax: +212 746 4879; e-mail: pag204@med.cornell.edu

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