Education  |   March 2019
A Neurologic Examination for Anesthesiologists: Assessing Arousal Level during Induction, Maintenance, and Emergence
Author Notes
  • From the Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts (E.R.R.); the Feil Family Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, New York, New York (N.D.S.); the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (E.N.B); the Department of Brain and Cognitive Science, the Institute for Medical Engineering and Sciences, the Picower Institute for Learning and Memory, and the Institute for Data, Systems and Society, Massachusetts Institute of Technology, Cambridge, Massachusetts (E.N.B).
  • This article is featured in “This Month in Anesthesiology,” page 5A.
    This article is featured in “This Month in Anesthesiology,” page 5A.×
  • Submitted for publication July 12, 2017. Accepted for publication October 31, 2018.
    Submitted for publication July 12, 2017. Accepted for publication October 31, 2018.×
  • Address correspondence to Dr. Brown: 55 Fruit Street, Grey/Jackson, 444, Boston, Massachusetts, 02114. enb@neurostat.mit.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Education / Review Article / Central and Peripheral Nervous Systems
Education   |   March 2019
A Neurologic Examination for Anesthesiologists: Assessing Arousal Level during Induction, Maintenance, and Emergence
Anesthesiology 3 2019, Vol.130, 462-471. doi:10.1097/ALN.0000000000002559
Anesthesiology 3 2019, Vol.130, 462-471. doi:10.1097/ALN.0000000000002559
Abstract

Anesthetics have profound effects on the brain and central nervous system. Vital signs, along with the electroencephalogram and electroencephalogram-based indices, are commonly used to assess the brain states of patients receiving general anesthesia and sedation. Important information about the patient’s arousal state during general anesthesia can also be obtained through use of the neurologic examination. This article reviews the main components of the neurologic examination focusing primarily on the brainstem examination. It details the components of the brainstem examination that are most relevant for patient management during induction, maintenance, and emergence from general anesthesia. The examination is easy to apply and provides important complementary information about the patient’s arousal level that cannot be discerned from vital signs and electroencephalogram measures.