Department of Anesthesiology and Intensive Care Medicine Helsinki University Hospital University of Helsinki Finland
Measurements of adequacy of anesthesia and level of consciousness during surgery and intensive care
Johanna Wennervirta
Academic dissertation
To be presented, with the permission of the Medical Faculty of the University of Helsinki, for public discussion in the Sophie Mannerheim Auditorium of the Surgical Hospital, Kasarmikatu 11-13, Helsinki, on May 29th 2010, at 10 am. Supervised by
Docent Anne Vakkuri Department of Anesthesiology and Intensive Care Medicine Helsinki University Hospital, Peijas Hospital, Vantaa, Finland University of Tampere, Tampere, Finland and
Docent Markku Hynynen Department of Anesthesiology and Intensive Care Medicine Helsinki University Hospital, Jorvi Hospital, Espoo, Finland University of Helsinki, Helsinki, Finland
Reviewed by
Professor Satu Jääskeläinen Department of Clinical Neurophysiology Turku University Hospital, Turku, Finland University of Turku, Turku, Finland and
Docent Ilkka Parviainen Department of Anesthesiology and Intensive Care Medicine Kuopio University Hospital, Kuopio, Finland University of Kuopio, Kuopio, Finland
Opponent:
Professor Tero Ala-Kokko Department of Anesthesiology and Intensive Care Medicine Oulu University Hospital, Oulu, Finland University of Oulu, Oulu, Finland
ISBN 978-952-92-7152-8 (paperback) ISBN 978-952-10-6180-6 (pdf) Yliopistopaino Helsinki 2010
To my family
Contents
Abstract ...... 7 List of original publications ...... 9 Abbreviations ...... 10 1. Introduction ...... 12 2. Review of the literature ...... 14 2.1. Mechanisms of general anesthesia ...... 14 TTSTST ++ V +',- 3270'! !'"QTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTSV TTSTTTV+#2&7*VV 1. 02 2#Q TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTSW
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Methods for monitoring the depth of general anesthesia ...... 18 TTUTST)*','! *1'%,1TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTSZ TTUTTT ','+ * *4#-* 0!-,!#,20 2'-, ,"'1-* 2#"$-0# 0+2#!&,'/3#TTTTTTTTTTTTTTTTTTTTTTTTTTTTS[ TTUTUT00V 1#"',"'!#1 ,"+-,'2-01 ," 3"'2-07#4-)#".-2#,2' *TTTTTTTTTTTTTTTTTTTTTTTTTTTTS[ 2.4. Measurements of analgesia during general anesthesia ...... 19 TTVTST32-,-+'! 0# !2'-,1TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTR TTVTTT2&-2-.*#2&71+-%0 .&722TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTR TTVTUT530%'! *520#11%,"#655%Q530%'! *2*#2&%,"#652%TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTS 2.5. 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2.6. Neuromonitoring in the intensive care unit ...... 33 TTXTS-,',4 1'4#+#2&-"1TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTUU 00TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTUU %5',%)<TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT