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At least 685 records · Page 38Linked to original sources
PubMed1981

Comparison of CB5 and V5 leads for intraoperative electrocardiographic monitoring.

Electrocardiogram lead CB5 was compared with lead V5 kin 27 patients undergoing coronary artery bypass graft surgery. Lead CB5 is a bipolar lead consisting of a negative electrode over the center of the right scapula and the positive electrode over the fifth interspace in the anterior axillary line. Comparison of CB5 and V5 tracings made while the chest was closed showed the ventricular deflections to be 20% larger in the CB5 lead. The ventricular deflections were highly correlated (r = 0.95 to 0.98). The average P wave voltage was 90% greater in the CB5 lead, and the relative increase in P wave voltage was greater (p less than 0.01) than the 20% increase in the RS deflection. Tracings made while the chest was open gave similar results. The CB5 lead is simple to apply and provides tracings equivalent to the V5 when monitoring for ischemia while allowing easier recognition of P waves.

Adult↗
PubMed2003

Intraoperative transesophageal sonographic monitoring of tumor thrombus in the inferior vena cava during radical nephrectomy and thrombectomy for renal cell carcinoma.

We report the case of a 58-year-old woman with renal cell carcinoma in whom real-time transesophageal sonographic monitoring of the tumor thrombus in the inferior vena cava provided dynamic information, allowing us to determine the appropriate operative procedure to use. Observation of the thrombus throughout the operation showed that mobilization of the liver resulted in compression of the inferior vena cava against the spine, increasing the risk of migration of the tumor thrombus and reinforcing the need to maintain adequate positioning of the liver to prevent such compression. The surgery was completed successfully, and the patient's postoperative course was uneventful. We recommend the use of real-time transesophageal sonographic monitoring of the tumor thrombus during such surgical procedures.

Carcinoma, Renal Cell↗
PubMed2004

Intraoperative transcranial ultrasonic monitoring for cardiac and vascular surgery.

The brain is the only organ not routinely monitored by any direct method during the administration of anesthesia. Anesthesiologists rely primarily on indirect physiologic evidence provided by blood pressure, peripheral pulse oximetry, heart rate, and respiratory and anesthetic gas concentrations to determine that brain blood flow and oxygenation are adequate. The reasons for this practice are that: (1) after millions of anesthetics significant numbers of adverse neurologic outcomes have not occurred, (2) the interpretation of transcranial Doppler, electroencephalogram, and near-infrared cerebral oximetry requires experienced personnel, and (3) the evidence of cost-benefit to support monitoring is limited. Brain monitoring generally has been confined to procedures where the brain is exposed to unique insults and risks specific to the procedures and where reliance on indirect physiologic evidence of cerebral integrity has been proven to be unreliable. Transcranial Doppler monitoring is valuable in the assessment of established surgical techniques, refinement of recent surgical techniques, and development of new techniques and instrumentation. Brain monitoring with transcranial Doppler is of particular value when deviations from established surgical or anesthetic techniques may place the brain at risk for cerebral hyper- or hypoperfusion, gaseous or particulate embolization, or their combined effects. This paper discusses applications of transcranial Doppler in coronary artery bypass surgery, aortic arch procedures, pediatric cardiac surgery, carotid endarterectomy, and a few other special cases. The insight into cerebral physiology is unique to the continuous window on the brain that transcranial Doppler provides.

Aorta↗