Publication: Análisis del registro computerizado simultáneo de bis espectral y entropía de estado en la inducción anestésica con etomidato, tiopental y propofol
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2017-02-03
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Universidad Complutense de Madrid
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Abstract
El estado de completa ausencia de percepción con carencia total de memoria implícita o explícita y falta de respuesta autonómica a estímulos nocivos en el marco de una completa estabilidad hemodinámica es la situación óptima y deseable durante la mayor parte del acto anestésico, sin embargo a lo largo de la historia, la mayoría de autores han encaminado sus esfuerzos a evitar el dolor, antes que a influir sobre el estado de conciencia, siendo la somnolencia o incluso el coma considerados como efectos secundarios habituales e inevitables de los productos utilizados para mitigar ese dolor. El concepto actual de los componentes de la anestesia diferencia éstos en corticales (inconsciencia o hipnosis y amnesia) y subcorticales (analgesia , antinocicepción, relajación neuromuscular y protección de la estabilidad autonómica, neurohormonal y hemodinámica), siendo los componentes corticales los mas difíciles de evaluar. La monitorización instrumental complementando la vigilancia de signos clínicos constituye el estándar de vigilancia perioperatoria actual...
The instrumental monitoring to complete the observation of clinical signs is the current standard of perioperative monitoring. The current concept of the components of anesthesia could be classified in cortical (unconsciousness or hypnosis and amnesia) and subcortical (analgesia, antinociception, neuromuscular relaxation and protection of autonomic, neurohormonal and hemodynamic stability), being the most difficult to assess cortical components as precise and sophisticated instruments that have not been available to anesthesiologists until recently required. Throughout history, most authors have focused their efforts in avoiding pain rather than in influencing the state of consciousness, with drowsiness or coma considered normal and inevitable side effects of drugs used to mitigate that pain. During the first half of the nineteenth century pioneer physicians of modern anesthesia undertook spectacular demonstrations and even though some of them were not entirely satisfactory they, at least, made the medical profession consider the importance of unconsciousness in alleviating the suffering of patients. The latest advance in monitoring the hypnotic depth has been the development of electronic monitors used nowadays on a computer analysis of the EEG signal...
The instrumental monitoring to complete the observation of clinical signs is the current standard of perioperative monitoring. The current concept of the components of anesthesia could be classified in cortical (unconsciousness or hypnosis and amnesia) and subcortical (analgesia, antinociception, neuromuscular relaxation and protection of autonomic, neurohormonal and hemodynamic stability), being the most difficult to assess cortical components as precise and sophisticated instruments that have not been available to anesthesiologists until recently required. Throughout history, most authors have focused their efforts in avoiding pain rather than in influencing the state of consciousness, with drowsiness or coma considered normal and inevitable side effects of drugs used to mitigate that pain. During the first half of the nineteenth century pioneer physicians of modern anesthesia undertook spectacular demonstrations and even though some of them were not entirely satisfactory they, at least, made the medical profession consider the importance of unconsciousness in alleviating the suffering of patients. The latest advance in monitoring the hypnotic depth has been the development of electronic monitors used nowadays on a computer analysis of the EEG signal...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Farmacología, leída el 24/11/2015