Department of and Helsinki University Hospital University of Helsinki Finland

Measurements of adequacy of 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 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