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At least 775 records · Page 43Linked to original sources
PubMed1986

Continuous intraoperative electroencephalographic monitoring in carotid endarterectomy.

Continuous electroencephalographic (EEG) monitoring was done during 143 consecutive carotid endarterectomies in 130 patients to detect intolerance to cross-clamping. An intraluminal shunt was inserted when EEG changes appeared (in the first 100 procedures) or when EEG changes appeared and a long clamping time was supposed (in the last 43 cases). 121 patients had no EEG changes at clamping time and only 1 had a postoperative deficit due to embolization, which occurred before clamping and was revealed by a decrease of voltage on tracing. 15 patients showed early (within 4 min after clamping) changes and in 11 patients shunting led to the reversal of EEG anomalies in all cases but 2. The state of these 2 patients was worse after surgery, in one because of embolic problems, in the other (shunted 30 min after clamping) probably for hemodynamic reasons. 4 patients with early EEG changes, not shunted because of the short clamping time, had no neurological deficit. 7 patients, 2 of which were shunted, showed late (after 4 min) EEG changes. Only 1 nonshunted patient in this group awoke with a minor, transitory neurological complication. Moreover, EEG changes have been correlated with the preoperative clinical condition and with the presence, on angiography, of contralateral carotid lesions. Also, EEG findings have been correlated with the computed tomography data (in 71 cases) and with the values of interior carotid artery (ICA) back pressure (in 58 cases). No possibility to predict the tolerance to clamping appeared from these correlations. However, a relatively higher risk of intolerance to clamping in patients with contralateral ICA occlusion was noted.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteriosclerosis↗
PubMed2003

Anesthesiologic aspects of laparoscopic fundoplication for gastroesophageal reflux in children with chronic respiratory and gastroenterological symptoms.

INTRODUCTION: During the past three decades laparoscopy has significantly improved. As fundoplication extensively benefits by the great advantages of the minimally invasive approach, many surgeons chose laparoscopic fundoplication for the treatment of gastroesophageal reflux in adults and children as well. Pneumothorax, cardiovascular collapse, hypoxia, and hypercarbia are some of the anesthesiologist's principal fears during carbon dioxide insufflation. Thus, monitoring cardiovascular and respiratory status is mandatory to early detect any complication and to maintain a proper balance during pneumoperitoneum. MATERIALS AND METHODS: At Gaslini Children's Hospital we performed a prospective nonrandomized study aimed at describing the main cardiorespiratory changes produced by pneumoperitoneum in 33 pediatric patients operated on by laparoscopic fundoplication between January 2000 and June 2001. Patients were divided into two groups; namely, group A and group B. Group A included 14 patients with chronic respiratory symptoms, and group B included 19 children who preoperatively mainly emphasized gastrointestinal symptoms. We monitored intraoperative cardiorespiratory status, timed length of surgery, and described intraoperative complications. RESULTS: No significant cardiovascular changes occurred during carbon dioxide insufflation. Partial oxygen saturation remained still in all the patients. End tidal CO2, meanly higher in group A children, increased in all the patients after pneumoperitoneum creation, but never exceeded 45 mmHg. Similarly, peak inspiratory pressure increased in all the patients, but was always maintained within acceptable values. Finally, group B patients required a harder and slower surgery, whose length seems to be negatively influenced by age. No intraoperative complication occurred. CONCLUSIONS: Carbon dioxide insufflation does not impair cardiovascular function, if intraabdominal pressure is maintained lower than 10 mmHg nor does it interfere with gas exchanges. Pneumoperitoneum slightly reduces ventilatory function, mainly in respiratory patients with various degrees of underlying bronchopulmonary impairments, but this effect is easily correctable. Thus, laparoscopic fundoplication is feasible and safe in both respiratory and gastroenterological patients, although surgery is easier and faster if periesophagitis is less evident.

Anesthesia↗
PubMed1975

Intraoperative physiologic monitoring and management during hepatic lobectomy using the liver isolation-perfusion technic.

The high operative mortality of major hepatic resection for tumor can be improved by a technic of resection using complete vascular isolation and hypothermic perfusion of the liver. Complete clamping of the portal vein, vena cava, and hepatic artery was necessary and well tolerated. Major physiologic, biochemical, and coagulation changes, however, can occur with this technic that requires close monitoring by the anesthesiologist. With astute observation and prompt corrective measures when indicated, these changes can be minimized to enable a safe and smooth resection to be carried out.

Acid-Base Equilibrium↗
PubMed2002

Stereotactic guided laser-induced interstitial thermotherapy (SLITT) in gliomas with intraoperative morphologic monitoring in an open MR: clinical expierence.

Stereotactic guided laser-induced interstitial thermotherapy (SLITT) is a minimal invasive method to produce thermonecrosis in cerebral tumour tissue. Clinical data are sparse due to its limited application until now and the value of this approach for tumour control and survival time remain to be defined. Twenty-four patients (7 low-grade gliomas, 11 anaplastic gliomas, 6 glioblastomas) with brain tumours, most recurrences, were treated with SLITT, in total 30 laser procedures were performed. Under local anaesthesia a 600 micro m laser-fiber was inserted by the stereotactic-guided technique. In open low-field MR the denaturation of the tumour by a Nd-YAG-laser (1064 nm) was monitored using T 1 -weighted 3-D turbo FLASH sequences. The ablation procedure had to be stopped twice because of neurological deficit, one major infection occurred. In two cases neurological improvement was observed. Mean survival times for low grade astrocytomas, anaplastic gliomas and glioblastomas were 144 months, 39 months, 17 months, respectively. Mean survival times after SLITT were 34 months, 30 months and 9 months, respectively. Mean times to progression after SLITT for the 3 histological subgroups were 16 months, 10 months and 4 months, respectively. Five patients with low grade astrocytoma and a KI greater or equal 70 maintained a high quality functional status for 11, 20, 21, 33 and 43 months. In anaplastic tumours patients maintained a KI of 70 for a median time of 15 months and for those with glioblastoma the respective high quality duration was 7.5 months after SLITT. SLITT for selected patients with glioma could have a clinical value in a multimodality treatment schedule maintaining quality of live. Due to the minimal invasive technique, the method is a therapy of choice and may be favoured to reoperation. Major indications of this treatment are small tumours, in eloquent regions and deep seated, as well as in older patients or patients in poor functional status.

Adult↗
PubMed1989

Intraoperative angioscopically monitored laser-assisted angioplasty in treating lower-extremity atherosclerotic occlusive disease.

As part of an ongoing multi-institutional study, our surgical center offered laser-assisted angioplasty to patients with significant, documented lower-extremity atherosclerotic occlusive disease, as an alternative to standard femoral-popliteal or femoral-tibial bypass. During the 1st 12 months of the study (September 1987 through August 1988), 31 patients had laser-assisted angioplasty in 34 limbs. The procedures were performed with an argon-powered laser probe that features a heated metallic tip and a window that furnishes 20% of the laser energy as a direct argon laser beam. Angioscopic monitoring was provided in each case. The immediate recanalization rate was 82% (28 of 34 limbs). After a follow-up period of 6 to 18 months (mean, 14 months), the patients continue to show clinical improvement of pretreatment symptoms, and noninvasive studies continue to reveal improved segmental arterial pressures. On the basis of this experience, we conclude that angioscopically monitored laser-assisted angioplasty has a role in the management of lower-extremity atherosclerotic occlusive disease.

Journal Article↗
PubMedDate not supplied

[Use of atracurium in patients with muscular diseases. 2 cases of distal and mitochondrial myopathy].

The successful management of 2 cases of rare myopathies, who underwent hemithyroidectomy, is here reported. Anaesthesia was induced with TPS and fentanyl, and maintained with isoflurane. Neuromuscular blockade was achieved by atracurium; neuromuscular monitoring by Neurostar-Medeleck was performed. This intraoperative monitoring allowed a quick recovery without complications.

Adult↗
PubMed1978

Intraoperative patient monitoring: a method of analyzing esophageal phonocardiograms.

The value of esophageal phonocardiography as a noninvasive monitor during anesthesia was studied in dogs. Esophageal phonocardiograms were analyzed using fast Fourier transform and least squares linear regression technics. This method has demonstrated that it is feasible to estimate two parameters of cardiac contractility--1/(PEP)2 and stroke power--and one parameter that demonstrates the state of the vasculature--total peripheral resistance. A continuous time (analog) processor that will accomplish this task is described.

Anesthesia↗
PubMed1980

Relationship of intraoperative EEG monitoring and stump pressure measurements during carotid endarterectomy.

Continuous electroencephalographic (EEG) monitoring has been generally accepted as the most sensitive detector of cerebral ischemia and need for an intraluminal shunt during carotid endarterectomy. More recently, internal carotid artery stump pressure has been proposed as a simpler and equally reliable indicator of possible inadequate cerebral perfusion. In this study, stump pressure measurements and EEG changes were compared in 80 carotid endarterectomies. The mean stump pressure for patients with ischemic EEG changes was 58 mm Hg, vs 66 mm Hg for those without EEG alterations (not statistically significant). Eleven of 17 patients with definite ischemic EEG changes had stump pressure greater than 59 mm Hg, a value generally equated with adequate cerebral perfusion. EEG interpretations and stump pressure predictions did not agree in 18 of 80 patients (22.5%). Stump pressure measurements should be used with caution as the sole monitor of cerebral ischemia and need for intraluminal shunting.

Blood Pressure↗
PubMed1995

Intraoperative and postoperative physiological monitoring practices by pediatric dentists.

The medical and dental literature has described successful sedations and those which have resulted in injury and death. Physiologic monitoring of patients is essential in assuring the success and safety of sedations in the dental office. The purpose of this study was to investigate the utilization and preferences of various physiologic monitoring methods and utilization of dentist anesthesiologists by pediatric dentists during sedations. Pediatric dentists in California were surveyed [n = 261] regarding monitoring methods in five different case scenarios. The most frequently utilized methods were clinical observation, pulse oximeter, and precordial stethoscope. Eighty seven percent of the pediatric dentists who use sedation do so without the involvement of a dentist anesthesiologist. Eighteen percent of pediatric dentists do not use any sedative agents in their practice. In the five case scenarios described in the survey, clinical observation was the most frequently utilized monitoring method during intra- and postoperative periods, followed by the pulse oximeter and precordial stethoscope. Intra- and postoperative monitoring varied with the complexity of the case scenario and most respondents monitored continuously. The trends observed from this study indicate that recent graduates use more sedative agents and find the pulse oximeter to be useful for physiologic monitoring during sedation.

Adolescent↗
PubMed1976

Monitoring of intraoperative heparinization in vascular surgery.

In 15 patients undergoing aortofemoral bypass, partial thromboplastin time (PTT) tests before and following intravenous administration of 75 U. per kilogram of heparin at zero, 30, 60, 90, and 120 minutes were determined for study of control of anticoagulant adequacy. The results demonstrate clearly that this amount provides excellent protection against thrombosis without bleeding complications. For intraoperative assay of heparin level effectiveness, the PTT test is advised. This test showed that a value of 250 percent of control still existed 75 minutes following the administration of heparin.

Aged↗
PubMed1999

The use of electrophysiological monitoring in the intraoperative management of intracranial aneurysms.

OBJECTIVES: Somatosensory evoked potentials (SSEPs) and brainstem auditory evoked potentials (BAEPs) have been increasingly utilised during surgery for intracranial aneurysms to identify cerebral ischaemia. Between July 1994 and April 1996, we surgically treated 70 aneurysms in 49 consecutive patients (58 operations) with the aid of intraoperative evoked potential monitoring. This study sought to evaluate the usefulness of SSEP and BAEP monitoring during intracranial aneurysm surgery. METHODS: Mean patient age was 51.9 (range 18-79) years. The sizes of the aneurysms were 3-4 mm (15), 5-9 mm (26), 10-14 mm (11), 15-19 mm (seven), 20-24 mm (six), and >25 mm (five). SSEPs were monitored in 58 procedures (100%) and BAEPs in 15 (26%). The neurological status of the patients was evaluated before and after surgery. RESULTS: Thirteen of the 58 procedures (22%) monitored with SSEPs had SSEP changes (12 transient, one persistent); 45 (78%) had no SSEP changes. Three of 15 patients (20%) monitored with BAEPs had changes (two transient, one persistent); 12 (80%) had no BAEP changes. Of the 14 patients with transient SSEP or BAEP changes, these changes resolved with adjustment or removal of aneurysm clips (nine), elevating MAP (four), or retractor adjustment (one). Mean time from precipitating event to electrophysiological change was 8.9 minutes (range 3-32), and the mean time for recovery of potentials in patients with transient changes was 20.2 minutes (range 3-60). Clinical outcome was excellent in 39 patients, good in five, and poor in three (two patients died), and was largely related to pretreatment grade. CONCLUSIONS: SSEPs and BAEPs are useful in preventing clinical neurological injury during surgery for intracranial aneurysms and in predicting which patients will have unfavourable outcomes.

Adolescent↗
PubMedDate not supplied

Perioperative arterial monitoring in patients with severe occlusive disease.

Special problems exist in the study and intraoperative monitoring of patients with severe occlusive vascular disease involving all extremities and with symptomatic brachiocephalic or coronary artery disease. We report 3 such patients who underwent arteriography via a percutaneous translumbar aortic catheter. All patients then underwent successful arterial reconstructive procedures utilizing the same translumbar catheter for arterial pressure monitoring and blood gas analysis. Percutaneous translumbar aortic catheters provide both a safe method for studying patients with four extremity occlusive vascular disease and reliable arterial access to monitor these patients intraoperatively.

Aged↗
PubMedDate not supplied

[Intraoperative facial nerve monitoring. Practical remarks].

OBJECTIVE: Even the most experienced surgeon may have difficulties in identifying and preserving the facial nerve, particularly when the operation is complicated, for example, by size and localization of tumour, trauma or anatomic variations. The aim of this study is to present indications, technics and interpretation of intraoperative facial nerve monitoring. METHODS: This study bases on literature review and our own experience in intraoperative facial nerve monitoring. CONCLUSIONS: Intraoperative facial nerve monitoring is helpful during excision of large and middle size acoustic neuromas, because preservation of facial nerve function improves with use of electrical monitoring. Intraoperative monitoring during other kinds of operation, which are likely to impact on the facial nerve may also be of benefit. This however, is hardly proved in the literature. Its seems, that electrical intraoperative monitoring is more sensitive than pneumatic motion detector system. Intraoperative monitoring is an adjunct, not replacement, to surgeon's experience and ability. The presence or absence of facial evoked responses must be interpreted within the context of surgical procedure, bearing in mind possibility the of false-positive and false-negative errors.

Electromyography↗
PubMed1998

Intraoperative and postoperative kinetics of serum tumor markers in patients with oral carcinoma.

PURPOSE: There are no reliable laboratory procedures to monitor intraoperative tumor antigen dispersal in patients with squamous cell carcinoma of the head and neck. This study evaluated the use of serologic parameters as perioperative indicators of systemic manifestations. PATIENTS AND METHODS: In 28 patients, serial measurements of different tumor markers (squamous cell carcinoma antigen, carcinoembryonic antigen, carbohydrate antigen 19.9, carcinoma antigen 125) were made preoperatively, intraoperatively, and postoperatively at short intervals to determine the influence of tumor ablation on the antigen concentration in the serum. A microparticle enzyme immunoassay was used for the serologic analysis. RESULTS: Squamous cell carcinoma antigen showed elevated serum levels preoperatively, which increased intraoperatively and decreased significantly postoperatively. The serologic examinations in the control group and the other tumor markers showed no correlation with the clinical situation. CONCLUSIONS: The results suggest that the titer of squamous cell carcinoma antigen in serum has a positive correlation with the tumor burden and the operative trauma in the case of surgery. These results support the value of intraoperative and postoperative serum antigen monitoring.

Adult↗
PubMed2005

Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 15: electrophysiological monitoring and lumbar fusion.

Based on the medical evidence provided by the literature reviewed, there does not appear to be support for the hypothesis that any form of intraoperative monitoring improves patient outcomes following lumbar decompression or fusion procedures for degenerative spinal disease. Evidence does indicate that a normal evoked EMG response is predictive for intrapedicular screw placement (high NPV for breakout). The presence of an abnormal EMG response does not, however, exclude intrapedicular screw placement (low PPV). The majority of clinically apparent postoperative nerve injuries are associated with intraoperative changes in SSEP and/or DSEP monitoring. For this reason, changes in DSEP/SSEP monitoring appear to be sensitive to nerve root injury. There is a high-false positive rate, however, and changes in DSEP and SSEP recordings are frequently not related to nerve injury. A normal study has been shown to correlate with the lack of a significant postoperative nerve injury. There is no substantial evidence to indicate that the use of intraoperative monitoring of any kind provides useful information to the surgeon in terms of assessing the adequacy of nerve root decompression at the time of surgery.

Electromyography↗