Abstract
Prevention, using multimodal monitoring, is crux regarding complications of neurosurgical anesthesia. The word c r u x is used advisedly, because dictionary lists several meanings-a l l applicable here. The arguments pro and con monitoring (in general) are still controversial and apply in varying degrees to present-day neurosurgical anesthesia. An example is whether somatosensory evoked potential (SSEP) wave forms or conventional electroencephalography (EEG) show a superior method of detecting cortical cerebral ischemia during carotid vascular surgery. 3 Part of problem is interpretation of outputed wave forms, because the operating room is a hostile environment for detection, amplification, and processing of very low scalp potentials; there are numerous sources of electrical noise that can overwhelm detection of physiologic signals4; also, type of anesthetic agents should be monitor-fr iendly (eg, effect on evoked potentials). The chapter by Pace 4 in its entirety (pp 173-202) is of inestimable value and clarity in presenting (exposing) problems of monitoring and devices so used. The problems that complicate administration of anesthesia outside operating room (as they pertain to magnetic resonance imaging [MRI], computed tomography [CI], interventional, radiology, radiation therapy, and angiography) have been well addressed by Forbes. 5
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