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Results for “Monitoring, Intraoperative”

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At least 649 records · Page 36Linked to original sources

PubMed2006

Enhancement of the bulbocavernosus reflex during intraoperative neurophysiological monitoring through the use of double train stimulation: a pilot study.

OBJECTIVE: Electrophysiological bulbocavernosus reflex (BCR) testing, during surgeries in which the constituent neural components are at risk, might supplement other low sacral (S2-4) stimulation/recording techniques. However, intraoperative BCR is not always reliably implemented. We proposed to analyze BCR signals in five surgical patients monitored with the novel application of double train stimulation (DTS) to determine if the potential could be enhanced. METHODS: We prospectively planned a regime of DTS BCR with a series of intertrain delays in five monitored patients at risk for low sacral neural injury. Patients were maintained with propofol, opiate infusion, and low inhalant anesthesia without muscle relaxant. Cutaneous sensory nerves of the penis (or clitoris) were stimulated using two consecutive pulse trains (DTS). Intertrain delays were 75, 100, 125, 150, 175, 200, and 250 ms. For BCR recording, uncoated paired wires were inserted into the external anal sphincter (EAS) bilaterally. For each trial, waveform amplitude, duration, and turn count measures for the first (single train) and second (double train) response were recorded. Percent increase/decrease of the second train response compared to the first train response was calculated. RESULTS: There was at least a 30% increase in measures of amplitude, turn count, and duration of the second train response in 22/28, 22/28, and 14/28 of the total trials respectively. There was an insufficient number of independent observations to determine statistical significance. CONCLUSIONS: Intraoperative BCR is currently obtained with some difficulty using pulse train stimulation. Our preliminary evidence has identified BCR waveform enhancement using DTS and suggests that the reliability of intraoperative BCR acquisition may be further improved by the addition of this technique. Our data are insufficient to define the best intertrain interval.

Adult↗

PubMed1991

[Does covered tibial intramedullary nailing promote formation of a compartment syndrome? Perioperative and intraoperative continuous monitoring of compartmental pressure in covered tibial intramedullary nailing].

Between October 1988 and October 1989 we performed a continuously pressure monitoring with the infusion technique in the tibialis anterior and deep posterior compartment of the lower leg during the nailing of the tibia in complete fractures of the lower leg in 16 patients. We set up 2 groups of patients because of different pathophysiological conditions: patients, who were operated on a few days after trauma (Group A) and patients operated on months after the trauma (Group B) because of non-union of the tibia. The effects of the preoperative, intraoperative, and postoperative manipulations were recorded. In no case we saw a beginning compartmental syndrome, although very high pressures of 100 mmHg in Group A and 55 mmHg in Group B in the deep posterior compartment during reduction of the fracture were registrated. The registrated pressures correlated very well with the manipulations during the operation and were absolutely reversible after the ending of these manipulations. In our observation the closed tibia nailing does not favorize the development of a compartmental syndrome, if not done during the vulnerable phase after the first days after trauma, in blunt multiple trauma patients and during bleeding complications.

Adult↗

PubMed1995

Intraoperative endo-luminal ultrasound evaluation of urethral diverticula.

The imaging accuracy of a catheter-based endo-luminal ultrasound system was compared to traditional imaging techniques for surgical treatment of urethral diverticula in 7 women and 1 man. At surgical repair the urethra was catheterized directly with a 6.2F or 9F (12.5 or 20 MHz.) catheter-based ultrasound transducer, generating a 360-degree transaxial real-time image. The endo-luminal ultrasound images were compared with preoperative voiding cystourethrography (7 patients), transvaginal ultrasound examinations (3) and double balloon urethrograms (2). Surgical diverticulectomy was then done with endo-luminal ultrasound monitoring. Intraoperatively, all diverticula were well visualized by endo-luminal ultrasound, which demonstrated improved identification of the size and orientation of urethral diverticula, sludge within the diverticula, the extent of periurethral inflammation, diverticular wall thickness, and the distance between the diverticular wall and urethral lumen. In 3 patients the urethral connections of the diverticula were exceptionally well visualized. Comparison with traditional imaging revealed 2 false-negative and 1 false-positive voiding cystourethrograms, 1 false-negative transvaginal ultrasound study and 1 false-negative double balloon urethrogram. Intraoperative monitoring of the urethra enabled precise anatomical dissection, eliminated all diverticular components, and prevented inadvertent urethral and bladder neck injury. Urethral endo-luminal ultrasound is a valuable new adjunct in the evaluation of a variety of urethral abnormalities. This new ultrasound application permits visualization of the precise size, location, orientation and characteristics of urethral diverticula and surrounding tissues. Through enhanced imaging, surgical repair is facilitated. Further application of this technique should increase the diagnostic accuracy of urethral imaging beyond radiographic techniques currently available.

Catheterization↗

PubMed2000

[Intraoperative electromyographic recurrent laryngeal nerve identification as a routine measure].

In recent years, two methods of intraoperative monitoring of the laryngeal nerve have mostly been used: evoked electromyographic responses via endscopically applied needle electrodes inserted into the adducting laryngeal muscles, and non-invasive electrodes like special tubes with integrated electrodes or separately insertable electrodes like the postcricoid electrode or disposable electrodes attached to the tube, as used in this study. The incidence of recurrent nerve paresis or paralysis during the IRM period was 1/174 nerves (0.6%). The advantage of the IRM is the quick and certain identification of the nerve; intraoperative monitoring cannot replace a proper surgical technique. We conclude that the IRM, using a laryngeal surface electrode attached to the tube, is a safe and reliable method.

Adult↗

PubMed1998

Intraoperative vascular monitoring of ipsilateral vs. contralateral TRAM flaps.

Transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction has become an increasingly common procedure in the 1990s. The original description of the procedure was that of an ipsilaterally based pedicled procedure. However, because of concerns about potential folding of the pedicle with possible compromise of the vascular supply, with full muscle harvest the contralateral flap soon became the flap of choice. Subsequently there have been several large clinical series of pedicled TRAM flaps reported showing a relatively high complication rate related to problems with flap vascularity. These findings resulted in many centers favoring free TRAM flap breast reconstruction, despite an increased resource utilization and negligible differences in complication rates. Ipsilateral pedicled TRAM flap breast reconstruction is not a commonly reported procedure, and is reserved for patients in whom scars preclude use of the contralateral pedicle. The ease of flap shaping and lack of tension on the pedicle is recognized by some, and the ipsilateral procedure has become the flap of choice for these surgeons. The authors hypothesized that ipsilateral TRAM flaps have less compromise of venous outflow as a result of the rotational tension effect of transposing the flap to the mastectomy site. To determine if the vascularity of the pedicled TRAM procedure is influenced by pedicle choice, an intraoperative clinical study was designed to compare intravascular pressures in the deep inferior epigastric artery and vein pedicle at various times from pedicle division to flap insetting. Ten consecutive ipsilateral TRAM flaps were compared with eight contralateral flaps. The deep inferior epigastric pedicle was cannulated with both an arterial and venous catheter, and pressures were monitored from the time of division of the inferior pedicle through to the time of flap insetting. The venous pressures of the contralateral flaps were significantly higher at flap rotation and flap insetting compared with the ipsilateral group (p = 0.014 and p = 0.022 respectively). Perfusion pressures showed a greater decrease in the contralateral group from the time of pedicle division to the point of flap rotation and flap insetting compared with the ipsilateral group (p = 0.081 and p = 0.055). The authors conclude that pedicle tension in contralateral TRAM flaps is more common and results in greater venous resistance and decreased perfusion pressures. Versatility in flap shaping, improved maintenance of the IMF, and lack of disruption of the natural xyphoid hollow gives ipsilateral TRAM flaps additional advantages.

Abdominal Muscles↗

PubMed1988

Intraoperative EEG monitoring: (II). Similarity analysis using density-modulated t array.

A method of showing the similarity, in other words, defining the difference between a pair of EEG patterns has been developed. By using the student t test on the power spectra at the appropriate frequency intervals, the t values obtained can be used as an indicator of the difference between the spectral patterns with respect to the frequency intervals. This so-called t-profile can be computed on real time basis and the result superimposed in different colors using the apparatus described previously to produce a 3-dimensional picture. We call this picture a density-modulated t array or DTA. Along with CSA and DSA (compressed/density-modulated spectral arrays), it proved to be a very powerful tool in intraoperative EEG monitoring.

Adult↗

PubMed1989

Intraoperative ultrasound monitoring of banding of the pulmonary trunk: a new technique?

We report an intraoperative real-time echo/Doppler study of the hemodynamic effects of banding of the pulmonary trunk in complete transposition seven years after a neonatal Mustard procedure. The patient had developed severe right ventricular failure. To prepare the left ventricle for an arterial switch procedure, banding of the pulmonary trunk was performed. While tightening the band, we monitored the pressure drop produced by using real time continuous wave Doppler interrogation. After banding, we used combined M-mode and cross-sectional echocardiography to image the left changes induced in left and right ventricular dimensions, shape and function by the acute change in hemodynamics.

Child↗

PubMed1999

[Influence of pavulon on facial nerve monitoring during middle ear-mastoid operation].

OBJECTIVE: To evaluate the influence of pavulon (muscle relaxant) on facial nerve monitoring for patient with middle ear-mastoid operation during general anesthesia. METHOD: Intraoperative monitoring of the facial nerve (FNM) was done in 45 ears (44 case). For patient with middle ear-mastoid disease, 38 ears underwent inhaled-intravenous anesthesia with muscle relaxant pavulon (group of general anesthesia), 7 ears underwent local anesthesia (group of local anesthesia). Accelography (ACCG) was used in 10 case for testing the correlation between of FNM and the various degree of recovery from ulnar nerve-musculor blockade. RESULT: FNM could be elicited during different periods of recovery with values of T4/T1 varying from 10%-98%. Pavulon could be used to eliminate muscular vibration from disturbing FNM. Electromyography (EMG) potentials were successfully recorded in 34 ears (89.4%). Anesthesia was uneventful and it may be controled satisfactority. CONCLUSION: Considering the advantage of pavulon. It can be used for general anesthesia during intraoperative monitoring of the facial nerve for children or adults suffering from local complicated diseases.

Adolescent↗

PubMed1996

Respiratory compliance during orthotopic liver transplantation.

After liver transplantation, respiratory complications are frequent. The purpose of this study was to assess if intraoperative monitoring of respiratory compliance is of clinical value in predicting such complications. Respiratory compliance was continuously monitored with a side-stream respiratory gas flow and pressure sensor (Datex, Helsinki, Finland) at the endotracheal tube in 18 adult patients undergoing orthotopic liver transplantation without veno-venous bypass. Respiratory compliance decreased along with blood volume expansion under anaesthesia before the start of surgery (P < 0.05). Compliance improved as ascites was removed at the beginning of laparotomy (P < 0.001). The highest compliance values were seen during liver surgery. In the patients without ascites preoperatively, compliance was lower at the end of surgery than at anaesthesia induction (P < 0.001). In the patients with ascites, compliance at the end of surgery was equally low as at anaesthesia induction. Compliance at the end of surgery was lower in the patients with bilateral than in those with right-sided or no pleural effusions in the postoperative chest X-rays (P < 0.001). In conclusion, intraoperative monitoring of respiratory compliance is one useful method for clinical use in predicting postoperative bilateral pleural effusions.

Anesthesia↗

PubMed1998

Automated intraoperative detection of Doppler microembolic signals using the bigate approach.

BACKGROUND AND PURPOSE: We undertook this study to evaluate the performance of an automated detection software in the detection of Doppler microembolic signals (MES) during cardiac surgery. METHODS: Intraoperative monitoring was performed over two spatially separated vessel segments of each middle cerebral artery in 18 patients undergoing coronary artery bypass surgery (n= 16) or cardiac valve replacement (n=2). All monitoring sessions were saved on digital audiotape and subsequently played back to the same ultrasound machine, set up to automatically detect MES by evaluating the temporary delay in their appearance between the two segments, in the presence of an experienced examiner. Software sensitivity and specificity in MES detection were then evaluated, with the results of the human observer considered the gold standard. RESULTS: A total of 44,933 high-intensity signals (artifacts and MES) were evaluated. Overall sensitivity and specificity of the software, with the human observer considered the gold standard, were 64% and 78.5%, respectively, ranging from 54% to 96% and from 74% to 90% in individual patients. When the overall results of the software were compared with those of the human observer, kappa was 0.72. CONCLUSIONS: The tested software displayed a satisfactory specificity. Provided that the sensitivity is further improved, it could provide a valuable tool in intraoperative monitoring.

Artifacts↗

PubMed2001

Minimally invasive video-assisted parathyroidectomy: multiinstitutional study.

Unilateral and minimally invasive parathyroidectomies with endoscopic and video-assisted technique have been introduced. Most of these procedures utilize preoperative localization and intraoperative monitoring of parathyroid hormone. There are only a few reports on these procedures. The objective of this study was to evaluate video-assisted parathyroidectomy (MIVAP) for surgery in patients with primary hyperparathyroidism (pHPT). From February 1997 to June 1999 a series of 123 consecutive patients with pHPT at four surgical centers were evaluated. The patients' ages ranged from 18 to 77 years (median 50 years). Preoperatively, sestamibi scintigraphy and ultrasonography for localization were performed for all patients. Selection criteria for a MIVAP procedure excluded patients with negative localization, suspicion of multiglandular disease (MGD) or thyroid malignancy, a large thyroid mass, and prior surgery or irradiation to the neck. MIVAP was performed with a 1.5 cm suprasternal incision; the operation was then done through this incision with a 30 degree 5 mm endoscope and microsurgical instruments with brief CO2 insufflation for adenoma identification. We then proceeded with an open technique through the small incision under video-assistance. Intraoperative monitoring of intact parathyroid hormone (iPTH) assays was used in all patients. Among the 123 patients in whom MIVAP was attempted, the procedure was accomplished in 109 (89%). Conversion to conventional cervicotomy was required in 14 (11%) patients because of failed localization, failure of the iPTH level to fall appropriately, or technical problems. There was no persistent or recurrent HPT during the 3 to 12-month follow-up. Oral calcium replacement for symptomatic hypocalcemia postoperatively was given in 7 (6%) cases. A unilateral transient laryngeal nerve palsy, resolving within 6 months postoperatively, occurred in two (2%) patients. The median hospital stay was 1.5 days (range 0.5-5.0 days). This study showed the feasibility of MIVAP as an alternative surgical treatment for pHPT in a selected group of patients. Further studies are necessary to evaluate the efficacy and rationale of MIVAP compared to other techniques for parathyroidectomy in pHPT patients.

Adenoma↗

PubMed2005

A prospective analysis of intraoperative electromyographic monitoring of posterior cervical screw fixation.

OBJECTIVE: This is a prospective study of 26 patients undergoing posterior cervical spine instrumentation with lateral mass or pedicle screws to determine the correlation between intraoperative screw stimulation thresholds and the position of posterior cervical lateral mass and pedicle screws. METHODS: One hundred forty-seven posterior cervical screws (122 lateral mass screws and 25 C7 pedicle screws) in 26 patients were electrically stimulated intraoperatively and stimulation thresholds recorded. Computed tomography (CT) scans were taken postoperatively and were evaluated independently to assess screw position. Electromyographic (EMG) thresholds and CT data were compared to assess the accuracy of the EMG screw stimulation technique in detecting screw malposition. RESULTS: Intraoperative electrical stimulation was accurate in verifying screw position. A stimulation threshold of 15 mA provided a 99% positive predictive value (89% sensitivity, 87% specificity) that the screw was within the lateral mass or pedicle. Stimulation values of 10-15 mA provided a 13% predictive value (66% sensitivity, 90% specificity) that the screw was within the lateral mass or pedicle. A stimulation value of <10 mA provided a 100% predictive value that the screw was malpositioned (70% sensitivity, 100% specificity). CONCLUSIONS: Intraoperative evoked EMG monitoring is a valuable tool in posterior cervical instrumentation using lateral mass and pedicle screws. Stimulation thresholds in this study correlated with screw position. Stimulation values of >15 mA reliably predict acceptable screw position. Values between 10 and 15 mA are generally associated with acceptable screw position, although exploration is recommended. Values below 10 mA are associated with screw malposition and warrant exploration, repositioning, and possible removal.

Bone Screws↗

PubMed2000

[Results and role of carotid endarterectomy].

BACKGROUND: The indications for carotid endarterectomy have been defined on the basis of several large prospective randomised trials. Today this operation is widely performed as primary and secondary stroke prevention in patients with high grade carotid artery stenosis. Permanent quality control of the surgical results is mandatory to ensure optimal stroke prevention and further reduce perioperative complications. METHODS: In this retrospective study we analyse the surgical results of 272 consecutive carotid endarterectomies performed in 260 patients with special emphasis on the prevention of intraoperative brain ischaemia. Patients were operated on in general anaesthesia and moderate hypothermia. Before clamping the arteries at the neck, a fast-acting barbiturate or propofol was administered intravenously to obtain burst suppression on the EEG. Transcranial Doppler sonography allowed continuous intraoperative monitoring of brain perfusion and detection of emboli. Intraoperative shunting was performed only when the collateral circulation was insufficient. RESULTS: The postoperative course was uneventful in 249 endarterectomies (91.5%). The internal carotid artery was sonographically recanalised at hospital discharge and at 6-week follow-up in all 249 cases. Ischaemic cerebral complications were observed in 7 patients (2.6%): minor reversible brain ischaemia in 4 (1.5%), and major brain ischaemia with infarction in 3 (1.1%). Three patients died in the perioperative period, representing a mortality rate of 1.1% in this series. The overall combined stroke and death rate was 3.7%. The combined major stroke and death rate was 2.2%. Various non cerebral complications occurred in 13 patients (4.8%). CONCLUSIONS: These results confirm that endarterectomy is a safe and efficient treatment for atherosclerotic carotid stenosis at the neck. Very low complication rates can be attained by non-invasive diagnostic methods combined with intraoperative monitoring of cerebral blood flow velocity. New upcoming endovascular therapies such as percutaneous angioplasty and stenting need to be compared with these current surgical results with regard not only to perioperative morbidity and mortality but also patency rate, restenosis, and intracerebral blood flow restoration.

Adult↗

PubMed2000

Incidence of venous air embolism during craniectomy for craniosynostosis repair.

BACKGROUND: Investigations to determine the incidence of venous air embolism in children undergoing craniectomy for craniosynostosis repair have been limited, although venous air embolism has been suspected as the cause of hemodynamic instability and sometimes death. A precordial Doppler ultrasonic probe is an accepted method for detection of venous air embolism and is readily available at most institutions. METHODS: A prospective study was conducted using a precordial Doppler ultrasonic probe in children undergoing craniectomy for craniosynostosis repair. The Doppler signal was continuously monitored intraoperatively for characteristic changes of venous air embolism. A recording was made of the precordial Doppler probe pulses, which was later reviewed by a neuroanesthesiologist, blinded to the intraoperative events. This information was correlated with the intraoperative events and episodes of venous air embolism were graded. RESULTS: Twenty-three patients were enrolled in the study during the 2-yr study period. Nineteen patients (82.6%) demonstrated 64 episodes of venous air embolism; six patients (31.6%) had hypotension associated with venous air embolism. Thirty-two episodes of hypotension were demonstrated in eight patients (34.7%). None of the patients developed cardiovascular collapse. CONCLUSION: The incidence of venous air embolism in our study of 23 children undergoing craniectomy for craniosynostosis was 82.6%. Though most episodes of venous air embolism during craniosynostosis repair are without hemodynamic consequences, the preemptive placement of a precordial Doppler ultrasonic probe is a noninvasive, economic, and safe method for the detection of venous air embolism. Prompt recognition may allow for the early initiation of therapy, thereby decreasing morbidity and mortality rates related to venous air embolism.

Child↗

PubMed2006

[Motor evoked potentials].

Motor dysfunction following spinal surgery and thoracoabdominal aortic surgery remain as one of their devastating complications. Since the development of postoperative motor dysfunction can deteriorate quality of life of patients, the prevention of such complications is an important clinical challenge. Recently, advances in stimulation technique using multipulse made intraoperative monitoring of functional integrity of motor pathways possible by recording myogenic motor evoked potentials (MEPs). However, myogenic MEPs can be affected by most of anesthetic agents and muscle relaxants. Anesthesiologists are therefore required to properly understand MEPs and to manage anesthesia carefully. We summarize the methods for monitoring of myogenic MEPs and anesthetic techniques during intraoperative MEP monitoring.

Anesthesia↗

PubMed2003

Influence of EEG monitoring on intraoperative stapedius reflex threshold values in cochlear implantation in children.

BACKGROUND: Cochlear implantation is a widely used means of treating deafness and severe hearing disorders. The surgical procedure includes inserting the cochlear implant electrode array into the cochlea and embedding the corresponding signal receiver in the mastoid bone behind the ear. Postoperative fitting of the externally worn speech processor is very important for successful use of the cochlear implant. For this purpose, electrically elicited stapedius reflex threshold values can be used. However, stapedius reflex threshold values measured intraoperatively are influenced by anaesthetics. The goal of this retrospective study was to find out whether electroencephalogram (EEG) control of anaesthesia produces more reliable reflex threshold values as a basis for the fitting of the speech processor. METHODS: Three groups of children, after surgery for cochlear implantation, were analysed with regard to the magnitude of intraoperative electrically elicited stapedius reflex threshold values and their deviations from postoperatively determined maximum comfortable levels (group 1: methohexital/remifentanil with EEG monitoring, n = 10; group 2: isoflurane/fentanyl with EEG monitoring, n = 9; group 3: isoflurane/fentanyl without EEG monitoring, n = 11). RESULTS: Children with EEG monitoring had significantly lower electrically elicited stapedius reflex threshold values and also significantly lower differences between intraoperative stapedius reflex threshold values and postoperatively determined maximum comfortable levels. CONCLUSIONS: Electroencephalogram monitoring in cochlear implantation is of considerable value in controlling anaesthesia and improving speech processor fitting based on more reliable intraoperative neurophysiological data.

Analysis of Variance↗

PubMed2003

Efficacy and limitations of current methods of intraoperative spinal cord monitoring.

The purpose of this study was to evaluate the efficacy and reliability of intraoperative spinal monitoring using spinal cord-evoked and compound muscle action potentials. We reviewed 716 cases of spinal monitoring performed over 15 years. The series contained 672 patients with spinal functions that could be monitored intraoperatively; 44 (6.1%) were impossible to record. Based on the 21 impossible-to-record patients, it is evident that missing a serious case such as a Frankel B type spinal cord injury indicates the limitations of the current monitoring methods for stimulating and recording. The monitoring outcomes were true-negative in 652 patients, true-positive in 12, false-negative in four, and false-positive in four. In two of the patients with false-negative results, postoperative myelomere motor paralysis was observed temporarily even though it was possible to record the muscle-evoked potential after electrical stimulation to the brain [Br(E)-MsEP] at the end of the operation. In cases in which the spinal parenchyma or spinal nerve root might be selectively damaged, Br(E)-MsEPs may not diagnose the disorder accurately. By employing multimodal monitoring, it should be possible to eliminate patients with false-negative results and to detect spinal disorders during the early stages, as well as to examine whether the abnormality that had been recorded by a single method is false-positive.

Action Potentials↗

PubMed1997

Intraoperative recording of the bulbocavernosus reflex.

OBJECTIVE: To demonstrate the feasibility of intraoperative monitoring of the bulbocavernosus reflex (BCR) as an indicator of the functional integrity of sacral nervous structures to aid in preventing their intraoperative injury. METHODS: Intraoperative BCR was elicited by electrical stimulation of the dorsal penile/clitoral nerve in 119 patients anesthetized with propofol, fentanyl, and nitrous oxide, with short-acting relaxant. Thirty-eight patients underwent surgery without risk, whereas 81 underwent surgery with risk of damage to sacral structures. Different patterns of stimuli were applied through silver/silver chloride disc electrodes placed on the dorsal aspect of the penis in males and over the clitoris (cathode) and adjacent labia (anode) in females. Recordings were made from the anal sphincter using intramuscular wire electrodes introduced within a 27.5 gauge needle, with two electrodes each inserted in the right and left hemisphincter muscles. Preoperatively, some patients had minor urinary problems in controlling their sphincters. RESULTS: The BCR was reliably recorded without habituation under this anesthetic regime. Optimal stimulating parameters were found to be double pulses (0.5-ms duration), with an interstimulus interval of 3 ms, stimulating rate of 2.3 Hz, and intensity of 20 mA. With these parameters, it was possible to record the BCR intraoperatively in all patients. Isoflurane and nitrous oxide significantly suppressed the BCR, and muscle relaxant completely abolished it. CONCLUSION: We demonstrated that it is feasible, under certain anesthetic regimes, to intraoperatively monitor the BCR in both children and adults (24 d to 74 yr of age) who did not have significantly affected function in sacral nervous structures.

Adolescent↗