術(shù)中知曉預防疼痛和腦功能監(jiān)測共術(shù)中知曉(intraoperativeawareness)：確切地說應(yīng)該稱之為全身麻醉下的手術(shù)中知16.7%左右。確定一個是否發(fā)生了術(shù)中知曉，除聽取的陳述外，還需要與參與該病事件能夠?qū)е滦g(shù)后在操作(performance)能力或行為(behavior)方面發(fā)生變化。術(shù)后術(shù)中知曉的用語，當前在國際上通用為5句話：WhatisthelastthingyourememberedbeforeyouwenttoWhatisthefirstthingyourememberedwhenyouwokeCanyourememberanythingbetweenthesetwoDidyoudreamduringyourWhatwastheworstthingaboutyour 人也可能不會主動報告。術(shù)中知曉的可能延遲，只有1/3的知曉病例是在出PACU前確定的；另有約1/3的知曉病例是在術(shù)后1～2報告的。推薦意見1：術(shù)后術(shù)中知曉的用語應(yīng)使用國際上通用的5句話。有關(guān)術(shù)中知曉的時機應(yīng)包括術(shù)后第一天和一周左右的2（A）一項待的多中心、大樣本的國內(nèi)術(shù)中知曉的顯示，術(shù)中知曉的發(fā)生率為0.4%，可疑知曉為0.4%，另有3.2%的術(shù)中有做夢的情況。級發(fā)生術(shù)中知曉可引起嚴重的情感和精神（心理）健康問題，據(jù)可高達30%～50%術(shù)中知曉出現(xiàn)性應(yīng)激后紊亂（Post-TraumaticStressDisorder，PTSD，其表現(xiàn)為術(shù)中知曉所造成的嚴重精神/醫(yī)學，近年已發(fā)展成為一個社會問題。ASA199979/41832006129/6811（PTSD三、術(shù)中知曉的發(fā)生機理和可能ASA4-5推薦意見4：雖然導致術(shù)中知曉的還沒有最終確定，但是高危知曉的發(fā)生率較普通增加5～10倍，即從0.1%～0.4%增加至1%（A級）卓類藥；（3）推薦意見5：建議麻醉科醫(yī)生在實施全身麻醉前要評價每一個發(fā)生知曉的程度。術(shù)前告之，特別是具有發(fā)生知曉高危因素的，術(shù)中有發(fā)生知曉的性。（C二氮卓類藥的使用可能導致蘇醒延遲。（B）確保麻醉中BIS值＜60。推薦意見8：目前沒有100%敏感性和特異性的預防知曉的監(jiān)測儀；根據(jù)文獻證實，能夠減少術(shù)中知曉發(fā)生率的腦功能監(jiān)測儀，目前只有監(jiān)護儀（B。但是仍缺少大樣本前瞻性隨推薦意見9：呼氣末濃度＞0.7MAC與BIS＜60在減少術(shù)中知曉方面沒有差別（B級） （BIS、聽覺誘發(fā)電位(AEP)、腦電非線性動力學分析參數(shù)、熵（Entropy、腦功能狀態(tài)指3 驗CC參考文獻SneydJR,MathewsDM.EditorialIII:Memoryandawarenessduringanaesthesia.BrJ 2008;100:742–4AvidanMS,ZhangL,BurnsideBA,etal.Anesthesiaawarenessandthebispectralindex.NEnglJMed2008;358:1097–108“PracticeAdvisoryforIntraoperativeAwarenessandBrainFunctionMonitoring”ApprovedbyASAHouseofDelegates,October2005.Availableat:WangY,YueY,SunYH,etal.InvestigationandysisofincidenceofawarenessinpatientsundergoingcardiacsurgeryinBeijing,China.ChinMedJ2005;118:1190-4LiuWHD,ThorpTA,GrahamSG,etal.Incidenceofawarenesswithrecallduringgeneral Anaesthesia1991;46:435-37MylesPS,WilliamsD,HendrataM,etal.Patientsatisfactionafteranaesthesiaandsurgery:Resultsofaprospectivesurveyof10,811patients.BrJAnaesth2000;84:6–10SandinRH,EnlundG,SamuelssonP,etal.Awarenessduringanaesthesia:Aprospectivecasestudy.Lancet2000;355:707–11SebelPS,BowdleTA,GhoneimMM,etal.Theincidenceofawarenessduringanesthesia:AmulticenterUnitedStatesstudy.Anesthg2004;99:833–9LennmarkenC,BildforsK,EnlundG,etal.Victimsofawareness.ActaAnaesthesiolScand2002;46:229–31DominoKB,PosnerKL,CaplanRA,etal.Awarenessduringanesthesia:Aclosedclaimsysis.Anesthesiology1999;90:1053–61BogetzMS,KatzJA.Recallofsurgeryformajortrauma.Anesthesiology1984;GoldmannL,ShahMV,HebdenMW.Memoryofcardiacanaesthesia:Psychologicalincardiacpatientsofintra-operativesuggestionandoperatingroomconversation.Anaesthesia1987;42:596–603LubkeGH,KerssensC,GershonRY,etal.Memoryformationduringgeneralanesthesiaforemergencycesareansections.Anesthesiology2000;92:1029–34RantaSO,HerranenP,HynynenM.Patients’consciousrecollectionsfromcardiacanesthesia.JCardiothoracVascAnesth2002;16:426–30 RantaSO,LaurilaR,SaarioJ,etal.Awarenesswithrecallduringgeneralanesthesia:Incidenceandriskfactors.Anesthg1998;86:1084–89 BulachR,MylesPS,RussnakM.Double-blindrandomizedcontrolledtrialtodetermineextentofamnesiawithmidazolamgivenimmediaybeforegeneralanesthesia.BrJAnaesth2005;94:300–5SidtG,BischoffP,StandlT,etal.ComparativeevaluationoftheDatex-OhmedaS/5entropymoduleandtheBispectralIndexmonitorduringpropofol–remifentanilanesthesia.Anesthesiology2004;101:1283–90SidtGN,BischoffP,StandlT,etal.ComparativeevaluationofNarcotrend,bispectralindex,andclassicalelectroencephalographicvariablesduringinduction,maintenance,andemergenceofapropofol/remifentanilanesthesia.Anesthg2004;98:1346–53McCannME,BrustowiczRM,BacsikJ,etal.Thebispectralindexandexplicitrecallduringtheintraoperativewake-uptestforscoliosissurgery.Anesthg2002;94:1474–8MylesPS,LeslieK,McNeilJ,etal.Bispectralindexmonitoringtopreventawarenessduringanaesthesia:TheB-awarerandomisedcontrolledtrial.Lancet2004;363:1757–63RecartA,GasanovaI,WhitePF,etal.Theeffectofcerebralmonitoringonrecoveryaftergeneralanesthesia:Acomparisonoftheauditoryevokedpotentialandbispectralindexdeviceswithstandardclinicalpractice.Anesthg2003;97:1667–74EkmanA,LindholmML,LennmarkenC,etal.ReductionintheincidenceofawarenessusingBISmonitoring.ActaAnaesthScand2004;48:20–6GajrajRJ,M,MantzaridisH,etal.ComparisonofbispectralEEGysisandauditoryevokedpotentialsformonitoringdepthofanaesthesiaduringpropofolanaesthesia.BrJAnaesth1999;82:672–8GreifR,GreenwaldS,SchweitzerE,etal.Musclerelaxationdoesnotalterhypnoticlevelduringpropofolanesthesia.Anesthg2002;94:604–8MychaskiwGII,HorowitzM,SachdevV,etal.Explicitintraoperativerecallatabispectralindexof47.Anesthg2001;92:808–9WongCA,FragenRJ,Fitzgerald