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PubMed1996

[Problems and limits in noninvasive oxygen monitoring].

Recently, professional anaesthesiologists organizations, have set up recommendations for intraoperative monitoring. These recommendations are based upon the assumption that anaesthesia-related deaths are largely preventable and that extensive monitoring will reduce mortality. Hypoxaemia appears to be an important pathophysiological mechanism, and this is why oxygen monitoring is given a high priority in safety standards in anaesthesia. However, no reduction in mortality has been definitively shown to follow the use of any monitoring device in randomized, controlled trials. Four techniques of oxygen monitoring are discussed and evaluated. Oxygen monitoring during inspiration can be recommended, although its implementation will probably prevent only a few anaesthesia-related deaths. Pulse oximetry is certainly highly recommended, but also has some deficiencies which are not sufficiently well known considering the popularity of this technique. Transcutaneous PO2 is considered mainly for historical reasons. Near infrared spectrometry is a new technique offering noninvasive and continuous monitoring of intracerebral oxygenation.

Anesthesiology↗
PubMed1995

Cerebrovascular carbon dioxide reactivity in carotid artery disease. Relation to intraoperative cerebral monitoring results in 100 carotid endarterectomies.

BACKGROUND: In patients with carotid artery disease, poor intracerebral collateralization is reflected by impaired cerebrovascular reactivity to carbon dioxide inhalation, which will improve after endarterectomy. The relationship between preoperative reactivity to carbon dioxide using transcranial Doppler sonography (TCD) and intraoperative changes of somatosensory evoked potentials (SEP) and TCD parameters were investigated. METHODS: In 94 patients, preoperative carbon dioxide reactivity was examined and defined impaired if mean blood flow velocity in the middle cerebral artery (Vm-MCA) increased less than 1.5% mmHg during carbon dioxide challenge. Patients then underwent 100 carotid operations under general anesthesia with both SEP and TCD monitoring. Shunts were placed if SEP amplitude decreased to less then 50% of control or central conduction time increased by 20% after clamping (critical SEP changes). TCD changes were defined as critical in case of a postclamping/preclamping Vm-MCA ratio < or = 0.4. The incidence of critical SEP and TCD changes was compared to preoperative carbon dioxide testing using Fisher's exact test with P < 0.05 considered significant. Postoperatively, neurologic state and carbon dioxide responsiveness were re-examined. RESULTS: Twelve patients showed impaired preoperative carbon dioxide reactivity on the side of operation, which improved markedly after surgery. The incidence of critical SEP changes in these cases (8.3%) was not significantly different from that in the remaining patients (14.8%). Critical SEP changes were significantly correlated with critical TCD changes (P < 0.0001). CONCLUSIONS: Patients with poor carbon dioxide reactivity (preoperative TCD testing) did not have an increased risk of cerebral ischemia during carotid surgery, as assessed by intraoperative SEP recording.

Blood Flow Velocity↗
PubMed1998

[Monitoring and maintenance of blood volume in intracranial surgery].

Intraoperative monitoring usually does not assess intravascular blood volume of the patient. The variations of the systolic blood pressure and the right auricular pressure allow to appreciate the intravascular blood volume changes and their consequences on the cerebral perfusion pressure. However, when the autoregulation of the cerebral blood flow is strongly depressed, the evaluation of the cerebral perfusion pressure alone is inadequate. In this case, the optimal monitoring should be metabolic (jugular bulb venous oxygen saturation) to finally assess the cerebral flow-metabolic coupling.

Anesthesia, General↗
PubMed1983

Precision and accuracy of intraoperative temperature monitoring.

Using tympanic membrane (TM) temperature as a standard for core temperature, we quantitated the accuracy and precision of seven other temperature monitoring sites during anesthesia, namely, the nasopharynx, esophagus, rectum, bladder, axilla, forehead, and great toe. Accuracy was quantitated as the difference between TM temperature and the temperature at each of the other sites; precision was quantitated as the correlation between TM temperature and the temperature at each of the other sites. Results indicate that the accuracy of measurements made using the great toe, forehead, and axilla is less than the accuracy of measurements made using the nasopharynx, esophagus, bladder, and rectum. Precision of measurements made using the nasopharynx, esophagus, and bladder is greater than the precision at the axilla, forehead, and rectum, and much higher than the precision at the great toe. Measurements of body temperature using the nasopharynx, esophagus, and bladder are recommended for intraoperative use as providing the best combination of accuracy and precision.

Adult↗
PubMed1986

[Surgery of high-flow arteriovenous malformation: with special reference to normal perfusion pressure breakthrough phenomenon].

Hemodynamic changes are of importance while removing large and high-flow arteriovenous malformations (AVM), because a phenomenon called "normal perfusion pressure breakthrough" may occur. In this report, we evaluated hemodynamic changes in 14 cases of high-flow AVM with cerebral angiogram and intraoperative monitoring of cortical-surface blood flow. The criteria we used for high-flow AVM are; nidus larger than 4 cm, a few large feeders, high-flow shunt in the nidus, and reduced circulation or dilated arteries in the adjacent brain tissue. For last 2 years, we experienced 14 cases of high-flow AVM which fulfilled the criteria, and 9 of these were operated on for total removal of AVM. Of those, 2 cases evolved postoperative local edema and hemorrhage and was thought to be due to "normal perfusion pressure breakthrough." Intraoperative monitoring of cortical-surface blood flow was useful to predict occurrence of "perfusion breakthrough", because blood flow in the adjacent brain tissue increased markedly with feeder clipping. Intraoperative barbiturate protection and postoperative controlled hypotension were thought to be useful for prevention of "normal perfusion pressure breakthrough", though the details of mechanisms are unknown.

Adolescent↗
PubMed2000

[Parathyroidectomy by elective route with perioperative measurement of parathyroid hormone. Report of 80 cases].

STUDY AIM: The aim of this study was to report a series of 80 patients treated by unilateral neck exploration for a sporadic primary hyperparathyroidism. PATIENTS AND METHOD: Between April 1992 and November 1998, 80 patients (65 women and 15 men, mean age: 63.5 years) with a single gland enlargement localized by ultrasonography, were operated on through a short unilateral neck incision, under general anesthesia in 72 cases and local in eight cases. The enlarged gland was removed with intraoperative pathological examination and intraoperative monitoring of parathyroid hormone. RESULTS: Mean duration of surgery was 25 minutes. There was no postoperative mortality or morbidity. Mean duration of hospital stay was two days. The enlarged gland was an adenoma in 75 cases and an hyperplasia in five. Adequate intraoperative parathyroid hormone decrease was observed. Postoperative calcemia was normal in 78 patients (97.5%). Among 76 surviving patients, with a 31-month follow-up, there was only a suspicion of persistent hyperparathyroidism in two patients. CONCLUSIONS: Minimal invasive approach by unilateral neck exploration may be performed with safety and efficiency in patients with a single gland enlargement under intraoperative monitoring of parathyroid hormone.

Adult↗
PubMed1982

Esophageal lead for intraoperative electrocardiographic monitoring.

The use and safety of the esophageal electrocardiogram for detection and diagnosis of dysrhythmias or ischemia during anesthesia was compared with the conventional electrocardiogram using leads II and V5 in 20 patients undergoing coronary artery bypass graft surgery. Using an intra-atrial electrocardiogram as the standard to provide detection and definitive diagnosis of dysrhythmias, the correct diagnosis from leads II and V5 was made in 53.8% and 42.3% of cases, respectively, whereas 100% of the dysrhythmias were properly diagnosed from the esophageal electrocardiogram (p less than 0.05). In two patients, the presence of a significant dysrhythmia was not detected using standard leads II and V5 alone. Large, distinct P waves, resulting from the proximity of the esophageal lead to the left atrium, clearly established the temporal relationship between atrial and ventricular depolarization. Posterior myocardial ischemia was diagnosed in one patient by ST-segment elevation in the esophageal electrocardiogram, whereas leads II and V5 did not demonstrate ischemic changes. No complications were encountered during the study. The esophageal lead is safe, simple to use, and provides valuable information for detection or diagnosis of dysrhythmias and myocardial ischemia during anesthesia.

Aged↗
PubMed2002

Glossopharyngeal nerve evoked potentials after stimulation of the posterior part of the tongue in dogs.

OBJECTIVE: Lower cranial nerve palsy is one of the most critical complications after posterior fossa surgery. However, no established monitoring procedures exist for glossopharyngeal nerve function. Therefore, glossopharyngeal nerve evoked potentials after stimulation of the posterior part of the tongue in dogs was studied to analyze whether glossopharyngeal nerve compound action potentials and evoked potentials are useful in the intraoperative monitoring of patients undergoing brainstem and cerebellopontine angle surgery. METHODS: Glossopharyngeal nerve action potentials and cortical potentials were evoked by stimulating the posterior part of the tongue in mongrel dogs. The potentials were evoked by supramaximal constant current electrical stimuli delivered with bipolar stainless steel needle electrodes and recorded with silver ball electrodes. RESULTS: Compound nerve action potentials were recorded from the exposed intracranial portion of the glossopharyngeal nerve. The latency of the initial negative peak of the action potentials was 2.8 +/- 0.6 milliseconds (mean +/- standard deviation; n = 17). Evoked cortical potentials were recorded on the coronal gyrus by stimulating the contralateral side. The latencies of the initial positive peak and negative peak were 20.1 +/- 3.7 and 35.7 +/- 8.2 milliseconds, respectively (n = 6). Ipsilateral tongue stimulation elicited biphasic evoked potentials on the coronal gyrus, which had small amplitudes and delayed latencies. Both compound nerve action potentials and cortical evoked potentials disappeared after sectioning of the glossopharyngeal nerve. CONCLUSION: The glossopharyngeal nerve action potentials and cortical potentials elicited by the stimulation of the posterior one-third of the tongue can be recorded. These evoked potentials represent a new means for intraoperative monitoring of patients undergoing surgery in the brainstem via the cerebellopontine angle, which involves the lower cranial nerves.

Action Potentials↗
PubMed1987

An intraoperative intraocular pressure monitor.

An autoclavable instrument based on piezoelectric principles for intraoperative monitoring of the intraocular pressure is presented. Accurate and rapid recordings of intraocular pressure during various surgical techniques are discussed.

Humans↗
PubMed1991

Intraoperative facial nerve monitoring.

Facial nerve monitoring is one of the most exciting innovations in otologic surgery in the past decade. Intraoperative monitoring has been shown to reduce the probability of iatrogenic injury to the facial nerve during surgery. It saves surgical time and reduces the anxiety level of both patients and surgeons. There are several reasons to use facial nerve monitoring: The surgeon nerve knows when it will be needed in a particular case, the operating room personnel become familiar with the equipment, and the surgeon learns how to interpret the sounds produced by the monitor and how to correlate them with surgical manipulations around the facial nerve. Facial nerve monitoring has added another dimension of safety to otologic and neurotologic surgery and has reduced the incidence of facial weakness or paralysis in the authors' surgical practice.

Facial Nerve↗
PubMedDate not supplied

[Invasion-free respiratory monitoring in thoracal surgery of oncology patients].

The results of intraoperative monitoring in thoracal surgery of 375 oncology patients with lung cancer were analyzed. The dynamic parameters of ventilation and blood gas composition were investigated in patients with uncomplicated anesthetic management and with complicated adequate ventilation. The diagnostic value of the above parameters is defined for optimizing the respiratory support in surgery for lung cancer.

Adult↗
PubMedDate not supplied

Monitoring of intraoperative auditory brain stem responses.

We believe that our initial experience establishes the fact that ABRs can be routinely and reliably performed in an operating room environment. There was no added risk to the patient, and operative delays were minimal. We did note transient fluctuation in latency values up to 1.5 msec. These changes would revert to baseline levels within five to ten minutes. Changes noted during drilling were probably related to the random noise produced. Case 3 was worrisome in that hearing was lost after maintenance of the ABRs during the surgical procedure. Evidently the vestibule was damaged, and a labyrinthitis caused the hearing loss. We feel that this procedure will be most useful in those situations in which the cochlear nerve and blood vessels are at risk. Such procedures as acoustic tumor removal with attempts to preserve hearing, vestibular nerve sections, and facial nerve problems in the IAC should be routinely monitored. Further experience will, of course, be most helpful in explaining and recognizing these changes.

Adult↗
PubMed1996

Transient compartment syndrome of the forearm after attempted radial artery cannulation.

Radial artery cannulation for continuous intraoperative monitoring of arterial blood pressure is considered a safe procedure. One complication of arterial cannulation is hematoma formation at the time of insertion or removal of the catheter. Bleeding is usually self-limited or will stop with compression without significant sequelae, even in the anticoagulated patient. We describe a case of hematoma with a transient compartment syndrome of the forearm after attempts to cannulate the radial artery for intraoperative monitoring purposes.

Aged↗
PubMed1987

[Motor potentials following spinal and transcranial stimulation: normal values for recording without voluntary pre-innervation].

The transcranial motor stimulation with a special, short discharging stimulator can assess the conduction of central motor pathways. Voluntary preinnervation of certain muscles leads to amplitude augmentation and allows reduction of the stimulus intensity. Preinnervation is impossible, if comatose patients are studied or if the method is used for intraoperative monitoring. We examined the spinal and transcranial stimulated motor responses of the muscle opponens pollicis without preinnervation in 18 healthy volunteers. The latencies after hemispheric stimulation showed an increase of latency of more than 2.5 ms compared with normative data from the literature which is significant on the .05-level. The central conduction time was prolonged also. The latencies of the spinal stimulated muscle potentials are comparable under both conditions. It is concluded that for intraoperative monitoring or the assessment of motor function in comatose patients one has to relay on normative values achieved without preinnervation.

Adult↗
PubMed2002

Minimally invasive parathyroid surgery in 103 patients with local/regional anesthesia, without exclusion criteria.

BACKGROUND: Parathyroid surgery for sporadic primary hyperparathyroidism (pHPT) can be accomplished with local/regional anesthesia and intraoperative monitoring of intact parathyroid hormone without exclusion criteria through a 1.0- to 1.25-inch (2.5- to 3.2-cm) incision (MIPL) in a high proportion of patients. METHODS: One hundred thirty-one consecutive patients with pHPT were offered MIPL. One hundred three patients elected to have this procedure. Patients were not excluded because of inadequate localization, previous parathyroid surgery, or need for concomitant thyroid surgery. Preoperative localization with ultrasound and/or sestamibi-single photon emission computed tomography scan was done in all patients. Almost all patients had intraoperative monitoring of intact parathyroid hormone (IMPTH). RESULTS: MIPL was accomplished in 89 of these 103 patients (86.4%), but 14 required conversion to general anesthesia. The main reasons for conversion were concomitant thyroid surgery, no positive preoperative localization, and previous parathyroid surgery. This procedure was accomplished in 13 patients requiring a bilateral procedure, 5 patients requiring thyroid surgery, 4 patients with no positive preoperative localization, and in 3 patients with previous parathyroid surgery. The complications of MIPL were comparable to the traditional bilateral exploration with general anesthesia. No patient experienced permanent hypoparathyroidism or postoperative bleeding. Two patients had transient recurrent laryngeal nerve paresis, and surgery failed to correct hypercalcemia in 5 (4.9%) of the patients. There appears to be less need for antiemetic medication in the MIPL patients compared with patients who had general anesthesia. CONCLUSIONS: Parathyroid surgery for sporadic pHPT can be accomplished through a 1.0- to 1.25-inch (2.5- to 3.2-cm) incision with local/regional anesthesia, without exclusion criteria. Accurate preoperative localization, particularly localization to the same site by both ultrasound and 99mTc-sestamibi scan, and IMPTH can limit the surgery to a unilateral approach. One should be cautious in proceeding with MIPL in patients with need for concomitant thyroid surgery, no preoperative localization, or previous parathyroid surgery.

Adult↗
PubMedDate not supplied

[The "Pulse" computer-based analyzer for measuring the pulse-wave and electric cardiac activity].

The paper deals with a device designed for the express-examination of the cardiac-vascular system through reading and processing the synchronously incoming electrocardiosignal and pulse-wave. The equipment is convenient for monitoring intraoperatively the functions of pacemaker due to its ability to select an optimal regimen not only for ECG but also for the pulse-wave. The new method of registering the pulse-wave by a miniature fiber-optic pressure sensor is described.

Cardiovascular Physiological Phenomena↗
PubMed1998

A survey on the intended purposes and perceived utility of preoperative cardiology consultations.

UNLABELLED: Cardiology consultations are often requested by surgeons and anesthesiologists for patients with cardiovascular disease. There can be confusion, however, regarding both the reasons for a consultation and their effect on patient management. This study was designed to determine the attitudes of physicians toward preoperative cardiology consultations and to assess the effect of such consultations on perioperative management. A multiple-choice survey regarding the purposes and utility of cardiology consultations was sent to randomly selected New York metropolitan area anesthesiologists, surgeons, and cardiologists. In addition, the charts of 55 consecutive patients aged >50 yr who received preoperative cardiology consultations were examined to determine the stated purpose of the consult, recommendations made, and concordance by surgeons and anesthesiologists with cardiologists' recommendations. Of the 400 surveys sent to each specialty, 192 were returned from anesthesiologists, 113 were returned from surgeons, and 129 were returned from cardiologists. There was substantial disagreement on the importance and purposes of a cardiology consult: intraoperative monitoring, "clearing the patient for surgery," and advising as to the safest type of anesthesia were regarded as important by most cardiologists and surgeons but as unimportant by anesthesiologists (all P < 0.05). Most surgeons (80.2%) felt obligated to follow a cardiologist's recommendations, whereas few anesthesiologists (16.6%) felt so obligated (P < 0.05). The most commonly stated purpose of the 55 cardiology consultations examined was "preoperative evaluation." Only 5 of these (9%) were obtained for patients in whom there was a new finding. Of the cardiology consultations, 40% contained no recommendations other than "proceed with case," "cleared for surgery," or "continue current medications." Recommendations regarding intraoperative monitoring or cardiac medications were largely ignored. IMPLICATIONS: We conclude that there seems to be considerable disagreement among anesthesiologists, cardiologists, and surgeons as to the purposes and utility of cardiology consultations. A review of 55 consecutive cardiology consultations suggests that most of them give little advice that truly affects management.

Anesthesiology↗