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Results for “Monitoring, Intraoperative”

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At least 811 records · Page 45Linked to original sources

PubMed1986

The use of brainstem auditory evoked potentials during posterior fossa surgery as a monitor of brainstem function.

Nine patients with unilateral ponto-cerebellar tumour, one with epidermoid, eight with acoustic neuroma had intraoperative monitoring of the brainstem auditory evoked potentials (BAEP) using bilateral scalp recording (Cz-A1 and Cz-A2) and binaural stimulation in order to monitor brainstem function during the surgery. Results were correlated with preoperative and postoperative BAEP findings. There was some intraoperative BAEP change in all the patients. Halothane anaesthesia caused bilateral wave V. prolongation in six patients. Lumbar drainage produced ipsilateral or bilateral wave V. prolongation in three of four patients in whom lumbar drainage was established. Opening the dura produced ipsilateral or bilateral wave V. depression or bilateral prolongation in four patients. Tumour dissection caused BAEP changes in all the patients: bilateral prolongation or depression in five patients, and ipsilateral prolongation and/or depression in six patients, three of them together with bilateral changes. The only patient who had no changes in wave I-IV. but in whom a big wave VI. appeared at the tumour side during removal, had epidermoid tumour. At the end of surgery there was some improvement in all patients, but in two the improvement was not striking: in one BAEP remained flat ipsilaterally, and in other, latency did not improve. All the patients had a good clinical recovery a few days later, but the control BAEP performed from the 3rd-7th postoperative day was not yet completely recovered in four patients. Intraoperative BAEP monitoring can be a useful technique to monitor brainstem function.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[Comparative analysis of the criteria for surveillance and monitoring in anesthesia, resuscitation and pain therapy. Recommendation of the Sociedad Española de Anestesia y Reanimación].

INTRODUCTION: One part of morbidity and mortality associated with anesthesia is due to accidents. It is thought that an additional monitoring can prevent and avoid most of anesthetic accidents. OBJECTIVES: In order to improve patient's safety and quality of anesthesia, Harvard University hospital approved in 1985 the rules for intraoperative monitoring. These were adopted by the American Society of Anesthesiologists (ASA) in 1986. In line with this procedure, professional associations of several countries pronounced their own rules. SEDAR did it in 1989. The purpose of this study was to compare spanish rules with those of America (Harvard and ASA), Australia, England and France. RESULTS: Comparative analysis revealed that the spanish norms are more extensive since they include not only the intraoperative anesthetic activities, but also those related to recovery, pain, and obstetric anesthesia. However, it has some deficiencies such as the lack of a periodical revision, and of an adaptative period and assistance to the anesthesiologist provided by auxiliary personnel. Successful points were the recognition that pulse oximetry is essential, the preoperative verification of all material, and, more importantly, is the only one that considers essential capnography in the assessment of ventilation and pulse oximetry during regional anesthesia and postoperative phase. CONCLUSION: Spanish norm is comparable to that of the other countries considered in this study. It shows important successful points and at the same time some significant deficiencies.

Analgesia↗

PubMed1998

Electrophysiological monitoring during selective dorsal rhizotomy, and spasticity and GMFM performance.

The relation between abnormal electrophysiological responses to intraoperative stimulation during selective dorsal rhizotomy (SDR) and the degree of spasticity and motor dysfunction was explored in 92 children with spastic cerebral palsy (CP) who underwent SDR at a single center. The proportion of abnormally responding rootlets was compared with the degree of spasticity measured with the modified Ashworth Scale (MAS) and with the spasticity measurement system (SMS) at discrete segmental levels. Motor impairment measured with the Gross Motor Function Measure (GMFM) was also compared with the proportion of abnormally responding dorsal rootlets. A consistent relation between the proportion of abnormally responding rootlets and the degree of spasticity and gross motor abnormality at the corresponding muscles could not be demonstrated. There was also no consistent association between the proportion of rootlets ablated during SDR and the change in spasticity measured with the MAS and SMS, or to the change in motor function as measured with the GMFM. These data suggest that the intraoperative monitoring technique most commonly used for SDR is unlikely to identify accurately those neural elements which contribute to spasticity in children with CP.

Adolescent↗

PubMedDate not supplied

[Anesthetic management of the surgical correction of heart valve defects combined with myocardial revascularization].

Thermodilution volumetry of the right ventricle (RV) in the course of combined operations has demonstrated significance of RV function and identified signs of its dysfunction when other parameters of hemodynamic monitoring were low informative. Of late, introduction of updated anesthetic modalities and intraoperative monitoring have noticeably improved surgical outcomes of combined lesions of the heart as shown by decreased hospital lethality.

Adult↗

PubMed1996

Carotid endartectomy.

This article provides an in-depth review of carotid endarterectomy for the treatment of occlusive carotid disease. Topics range from preoperative diagnostic assessment to postoperative complications. Key issues related to operative management, including anesthetic technique, intraoperative monitoring, cerebral protection, anticoagulation therapy, and intraluminal shunting, are emphasized. Operative techniques are discussed and illustrated in detail.

Anesthesia, General↗

PubMed2000

[First continuous nerve monitoring in thyroid gland surgery].

UNLABELLED: A new "all in one" sensing device was developed for continuous transtracheal intraoperative monitoring and in situ detection of the recurrent laryngeal nerve (RLN) during thyroid surgery. PATIENTS AND METHODS: The new system is based on a double-balloon endotracheal tube with integrated atraumatic stimulating and tracing electrodes. The recurrent laryngeal nerve is stimulated transtracheally and compound action potentials are recorded from the laryngeal muscles. Fifty-five patients were introduced into a phase-one clinical trial. Thirty-five patients with primary thyroid operations, 20 patients with reoperations, 10 of whom had neck dissections. All patients were evaluated laryngoscopically and phoniatrically by an ENT specialist before and after surgery. RESULTS: Compound muscle action potentials were recorded continuously during the whole operation and responded sensitively to tension and pressure to the nerve. There were no accidental permanent RLN palsies. CONCLUSION: The new system offers five advantages: (1) it is atraumatic; (2) it is easy to use; (3) it can monitor continuously with an audio feedback to the surgeon; (4) it works outside the operation field; and (5) it is highly sensitive, even indicating reversible irritation to the nerve.

Adult↗

PubMed1997

The use of ketamine or etomidate to supplement sufentanil/N2O anesthesia does not disrupt monitoring of myogenic transcranial motor evoked responses.

Intraoperative monitoring of myogenic transcranial motor evoked responses (tc-MERs) requires an anesthetic technique that minimally depresses response amplitudes. Acceptable results have been obtained during opioid/N2O anesthesia, provided that the concentration of N2O does not exceed 50%. However, this technique may necessitate supplementation with additional agents to achieve adequate depth of anesthesia. Etomidate and ketamine have been reported anecdotally or in nonsurgical situations to produce little tc-MER depression. We investigated the effects on tc-MER amplitude and latency of supplementation of a sufentanil/N2O anesthetic with etomidate or ketamine in patients undergoing spinal instrumentation. Anesthesia was induced with etomidate 0.3 mg/kg and sufentanil 1.5 mg/kg and maintained with sufentanil 0.5 mg/kg/h and N2O 50%. Muscle relaxation was kept at 25% of control. Paired transcranial electrical stimulation was performed. Each patient randomly received either ketamine (0.5 mg/kg) or etomidate (0.1 mg/kg) as a single bolus intravenously, during stable surgical conditions. Triplicate tc-MERs were recorded from the tibialis anterior muscles before and 2, 5, 10, and 15 min after drug administration. Administration of ketamine did not significantly change tc-MER amplitudes, whereas etomidate resulted in a transient amplitude depression to 72% of control (p < 0.05) at 2 min after injection. Latency remained unchanged with both drugs. In conclusion, the data suggest that both ketamine (0.5 mg/kg) and etomidate (0.1 mg/kg) can be used to supplement sufentanil/N2O anesthetic without disrupting tc-MER monitoring.

Adolescent↗

PubMed1983

Spinal cord monitoring during spinal surgery using somatosensory spinal evoked potentials.

Intraoperative monitoring of spinal cord function has been carried out in 59 patients during spinal instrumentation for scoliosis. Posterior tibial nerve stimulation in the popliteal space was performed and spinal evoked potentials from electrodes in the spinous processes observed. A rod artifact problem causing partial obliteration of the wave form can be minimized or eliminated by careful selection of the insertion of the fixation device. A drop in amplitude of the signal occurred in many of the tracings from control to distraction observations but did not result in neurologic deficit. One patient had a loss of the signal after maximum distraction with a Harrington rod and a return with release of distraction. This patient awoke with paralytic urinary bladder retention which resolved spontaneously but no other neurologic deficit. This method has been used for monitoring of spinal cord function during Harrington rod instrumentation, using both compression and distraction systems as well as Luque rod instrumentation. This method is safe, simple, and provides consistent and predictable wave forms; it appears to be reliable in indicating continuation of spinal cord function during the procedure.

Adolescent↗

PubMed1995

[Intraoperative facial nerve monitoring in parotid surgery].

Neurophysiological monitoring of cranial motor nerves has proved to be of value in cerebellopontine and skull base surgery. Unfortunately, facial nerve monitoring has been used infrequently for routine parotid gland surgery because suspicion of expense, possible unreliability and the requirement for extra personnel. This study presents clinical experience at the University of Erlangen with facial nerve monitoring during parotid gland surgery done by residents. Advantages are also emphasized for the experienced ENT-surgeon for use during revision parotidectomy. In 35 consecutive patients with benign parotid gland tumors intraoperative monitoring of the facial nerve was done using two different two-channel electromyography units. Bipolar coaxial electrical stimulation was superior to the monopolar stimulation mode. The average operative time and postoperative functional results were compared with those of a control group consisting of 24 patients without monitoring. Findings demonstrated a reduction is operative time and better functional outcome in the patient group with monitoring. Additionally four patients had to undergo total revision parotidectomy because of recurrent benign tumors, while one patient suffered from chronic parotitis due to sialolithiasis and required complete parotidectomy for relief of symptoms. No patient developed permanent facial paresis and nerve monitoring proved to be very helpful for identification and protection of the facial nerve in scar tissue.

Electric Stimulation↗

PubMed2006

The multimodal world of medical monitoring displays.

A vision of the future of intraoperative monitoring for anesthesia is presented-a multimodal world based on advanced sensing capabilities. I explore progress towards this vision, outlining the general nature of the anesthetist's monitoring task and the dangers of attentional capture. Research in attention indicates different kinds of attentional control, such as endogenous and exogenous orienting, which are critical to how awareness of patient state is maintained, but which may work differently across different modalities. Four kinds of medical monitoring displays are surveyed: (1) integrated visual displays, (2) head-mounted displays, (3) advanced auditory displays and (4) auditory alarms. Achievements and challenges in each area are outlined. In future research, we should focus more clearly on identifying anesthetists' information needs and we should develop models of attention in different modalities and across different modalities that are more capable of guiding design.

Anesthesia, General↗

PubMed1999

[Monitoring of the auditory stem evoked potentials in removal of tumors of the posterior cranial fossa].

The material of intraoperative monitoring of the acoustic stem evoked potentials (ASEP) in 9 patients with tumors of the stem and in 28 patients with the parastem localization was analyzed. It was shown that changes in the amplitude of ASEP rather than latency were the decisive factor in the assessment of the functional state of the brain stem. It was found that even the pronounced changes of the bioelectrical activity recorded during the excision of the tumor could be reversible after a change of the strategy of the operative intervention and/or after performing the necessary therapeutic measures. An important test of favorable prognosis of the postoperative course is considered to be the normalization of brain activity, ASEP included, at the final stages of the operation.

Adolescent↗

PubMed2000

Renal physiology. Laparoscopic considerations.

Oliguria is a recognized component of the physiologic effect of increased intra-abdominal or retroperitoneal pressure. The cause is multifactorial, emanating from vascular and parenchymal compression, and is associated with systemic hormonal effects. Ureteral obstruction does not play a significant role. These changes are pressure-dependent and are usually not apparent until pressures reach 15 mm Hg or more. This effect is not associated with any histologic pathology or evidence of renal tubular damage. After the release of the pneumoperitoneum or pneumoretroperitoneum, the renal function and urine output return to normal with no long-term sequelae, even in patients with pre-existing renal disease. The entire operative team must understand the physiologic effects of CO2 insufflation, which allows appropriate intraoperative monitoring and management and minimizes intraoperative and postoperative complications.

Animals↗

PubMed2005

Setup of neurophysiological monitoring with tcMEP/SSEP during thoracoabdominal aneurysm repair.

OBJECTIVES: The article describes a procedure for the intraoperative neurophysiological placement of electrodes to control the spinal cord function during thoracoabdominal aortic aneurysm repair. MATERIAL AND METHODS: Intraoperative monitoring is performed by motor-evoked myogenic potentials after transcranial electric stimulation (tcMEP) and somatosensory-evoked potentials (SSEP). In tcMEP, the stimulating percutaneous needle electrodes are placed at C3 and C4 according to the 10 - 20 system for EEG recordings. TcMEP are recorded from the anterior tibial and gastrocnemius muscles on both sides. The SSEP electrodes are placed laterally and caudally onto the malleolus medialis in order to stimulate the tibial nerve. The stimulus is documented via electrodes attached to the scalp within the sensory cortex region. RESULTS: The application of the electrodes is both easy to learn and can be performed without further difficulties. Once attached, the electrodes provide a quick assessment and interpretation of spinal cord function. The identification of external sources of disturbance during the monitoring (e. g. insufficient impedance, unfavourable electrode positioning, and technical interference caused by medical equipment) enables the supervisor to differentiate between normal and abnormal neurological responses. CONCLUSIONS: TcMEP and SSEP allow an adequate, direct, and reliable intraoperative assessment of spinal cord function, enabling the surgeon to diagnose an impending ischaemia and act accordingly. This measurement technique provides the surgical team with a means of integrating neurological aspects during thoracoabdominal aneurysm repair.

Aortic Aneurysm, Abdominal↗

PubMed2005

[Anesthesia for scoliosis surgery: preoperative assessment and risk screening of patients undergoing surgery to correct spinal deformity].

Spinal column deformity is associated with potentially serious alterations of respiratory and cardiac function. Such alterations, in association with the underlying disease that caused the deformity--such as neuromuscular disease--are risk factors that affect the prognosis for scoliosis patients undergoing anesthesia and surgery. It is important for the anesthesiologist to carry out a detailed preoperative assessment to identify patients at risk with the aim of decreasing morbidity and mortality related to surgical correction of deformities. Of paramount importance is awareness of the risk of injury to the spinal cord that will affect function. Other issues are how to manage the patient in anomalous positions, the risk associated with hypothermia secondary to exposure of a large surgical field for a long period, and bleeding, which can sometimes exceed the patient's total volume. In the case of scoliosis surgery, all those situations may converge, obliging us to provide careful intraoperative monitoring, particularly of spinal function; to choose the appropriate anesthetic technique; and to maintain vigilance during the early postoperative period to foresee possible complications. Because scoliosis surgery is multidisciplinary, several teams must work together to assure success.

Anesthesia↗

PubMed1996

Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy.

BACKGROUND: Parathyroidectomy has a success rate of greater than 95% in the hands of experienced surgeons. To maintain this result in a more cost-effective way, intraoperative monitoring of intact parathyroid hormone (iPTH) has been used to decrease operative times. This technique signals when all hyperfunctioning tissue has been excised or when further dissection is necessary. METHODS: Eighty-nine consecutive patients with hyperparathyroidism had plasma samples measured for iPTH levels during parathyroidectomy. Nine patients had previous neck explorations. Perioperative iPTH measurements using immunochemiluminescent assays with a turnaround time of 10 minutes were done after excision of each suspected abnormal parathyroid gland. RESULTS: All patients except one returned to and maintained normal calcium levels during the follow-up period of 8 months (range, 1 to 25 months). Prediction of postoperative calcium levels by means of quick immunochemiluminescent assay has a sensitivity of 97%, specificity of 100%, and an overall accuracy of 97%. Specific influence on surgical judgment was noted in four patients with multiglandular disease, in seven with difficult localization problems, and in one patient in whom the hyperfunctioning parathyroid tissue was not recognized. Monitoring the plasma iPTH levels during parathyroidectomy directly aided the surgeon's operative approach in these 12 patients. CONCLUSIONS: Intraoperative iPTH assay is useful with predictive accuracy of 97%. It influenced or changed the operative approach in 13% of patients.

Calcium↗

PubMed2004

[Online optical coherence pachymetry in laser in situ keratomileusis].

PURPOSE: Currently the microkeratome incision and the ablation depth are unpredictable in laser in situ keratomileusis (LASIK). Online optical coherence pachymetry is a high-resolution and non-contact method, which enables the corneal thickness changes to be monitored intraoperatively. METHOD. In 12 patients undergoing myopic LASIK, online optical coherence pachymetry with a wavelength of 1310 nm and a measurement frequency of 74 Hz was studied. The central corneal thickness changes were determined continuously. RESULTS: Online optical coherence pachymetry enabled intraoperative visualization and assessment of the central corneal thickness, the flap thickness after the microkeratome pass, the time-resolved ablation and the residual stromal thickness. Intraoperatively the mean flap thickness was 113+/-31 microm and the residual stromal thickness was 277+/-49 microm. The optically determined ablation depth was 116+/-30 micro m, which corresponded to 33 microm higher mean values than the nominal ablation depth. CONCLUSIONS: Online optical coherence pachymetry enabled the flap and residual stromal thickness to be measured intraoperatively. Also the individual ablation depth and possible dehydration effects of the cornea were monitored continuously. Thus, online optical coherence pachymetry could contribute to improve the safety standards during LASIK.

Adult↗

PubMed2002

Neuroanesthesia. Innovative techniques and monitoring.

Advances in neuromonitoring have provided insights into neurologic function during anesthesia. Despite the limitations and necessary caution when using intraoperative monitors to interpret neural function, these technologies have been definite steps in the right direction for assessing neural integrity and level of consciousness during anesthesia. The techniques discussed minimize the adverse sequelae of a variety of neurosurgical and orthopedic procedures, reducing the morbidity rates/risks in the perioperative period. Furthermore, it is likely that such monitoring will become a standard of care, similar to other monitoring standards such as pulse oximetry and capnography. Accurate and reliable monitoring is essential, and on-going large prospective studies comparing the processed EEG or evoked potential with definable end points in both adult and pediatric populations will be necessary. The use of monitoring, such as the BIS, may improve cost efficiency by reducing the total amount of drug used to maintain anesthesia, as well as enhance recovery. A danger in this process, however, is the potential for public opinion, outside regulatory bodies, or medico-legal implications to drive change and enforce standards of care before appropriate data are available.

Anesthesia↗

PubMed1994

Autonomic activities in hyperhidrosis patients before, during, and after endoscopic laser sympathectomy.

Three hundred palmar hyperhidrosis (PH) patients have been treated with video endoscopic laser sympathectomy during the last 2 years. Monitoring the palmar skin perfusion (PSP) and palmar skin temperature (PST) has been used intraoperatively to aid the confirmation of the correct sympathetic segment for laser ablation. The preoperative and postoperative PSP and PST and sympathetic skin response (SSR) also have been measured to evaluate the therapeutic effect of this method. An apparent increase of PSP would occur intraoperatively after the interruption of the T2 sympathetic segment, and then a gradual elevation of PST would follow after the extirpation of the segment. A rise of PST of about 3 degrees C after laser ablation of the appropriate segment indicated sufficient denervation of the hand and predicted long-lasting relief of PH. Furthermore, both PSP and PST also significantly increased after the operation. The postoperative elevation of the PST (usually about 3 degrees C) is similar to that recorded during intraoperative monitoring. The amplitude and the latency of SSR in the palm and sole were recorded both before and after sympathectomy. A remarkable decrease of palmar SSR amplitude and its ratio was found postoperatively by comparing it with that of plantar SSR in the same patient. These autonomic activity changes have correlated well with the postoperative satisfaction of the patients. Based on our study, the anatomic identification confirmed by the sympathetic monitorings has proved essential to achieve a definite and adequate sympathectomy leading to a satisfactory resolution of PH without the need of a tissue diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗