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Results for “Monitoring, Intraoperative”

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PubMed1998

[Near-infrared spectroscopy during hypothermic selective cerebral perfusion--a clinical study of its value].

The purpose of this study is to assess the value of near-infrared spectroscopic oxymetry (NIRO) in monitoring cerebral oxygenation and metabolism during selective cerebral perfusion (SCP) for surgery of the aortic arch. The measurement protocol during SCP comprised oxyhemoglobin (HbO2), deoxyhemoglobin (Hb), and total hemoglobin levels in the brain. From March 1994 through March 1997, 14 patients underwent surgical treatment of the aortic arch anomalies with intraoperative monitoring with NIRO. The temporary circulatory arrest was accomplished at a rectal temperature of 22 degrees C and the hypothermic SCP was employed for the cerebral protection. SCP was initiated at a flow rate of 10 ml/kg/min so as to maintain HbO2 at the same level as immediately before the circulatory arrest (baseline). The longitudinal changes of HbO2 level during the process revealed four different patterns and were grouped accordingly. Three of the patients maintained HbO2 level above the baseline during SCP (Group A). HbO2 level reached to the baseline at initial flow rate but decreased gradually thereafter in 4 patients (Group B). Gradual increment of the perfusion flow rate failed to elevate HbO2 level to the baseline in the 5 patients (Group C1). In this group, HbO2 level started to elevate about 60 minutes after the initiation of SCP. HbO2 level of the remaining 2 patients was absolutely resistant to the increment of SCP flow rate and kept low values throughout SCP (Group C2). All the patients recovered uneventfully without any neurological abnormality. Our analyses for the longitudinal behavior of the HbO2 level confirmed the previously reported evidences that the values were affected not only by perfusion flow rate but also by hemodilution, blood transfusion, and perfusion pressure. Furthermore, our present study disclosed another evidence that HbO2 level was strongly affected by subclavian steal phenomenon. Although there were no differences in the clinical outcome among the groups, referring to the theories that HbO2 level is better not to be departed from baseline level, it could be concluded that HbO2 level monitoring in the setting of the determined hematocrit and hypothermia was effective for securing the adequate demand and supply balance of the cerebral oxygenation. Our conclusion may extend further that NIRO is a useful means in determining the optimal perfusion flow rate of SCP during surgery of the aortic arch.

Aged↗

PubMed1991

Trigeminal evoked potentials in patients undergoing percutaneous microcompression of gasserian ganglion.

22 patients undergoing percutaneous microcompression of Gasserian ganglion for the treatment of trigeminal neuralgia were monitored intraoperatively by means of trigeminal evoked potentials (TEPs). The second trigeminal branch was stimulated at the maxillary foramen; evoked responses were recorded using subcutaneous electrodes placed over the scalp. TEPs presented several short-latency waves (called W1, W2, W3, P4, N5, P6, N10) which are generated before and after the ganglion (W1, W2, W3), in the brain stem (P4, N5, P6) and possibly in the cortex (N10); other waves occur within 150 ms after the stimulus (late waves). During compression, W1 did not change, while W2 and W3 as well as P4, N5, P6, N10 and late waves decreased in amplitude: this pattern was noted in the patients who presented with pain relief during the follow-up period. On the contrary, the patients who suffered from pain recurrence did not show similar intraoperative TEP changes. In conclusion, intraoperative TEP derangements may be related to the effectiveness of the compression on the Gasserian ganglion.

Aged↗

PubMed1996

Carbon dioxide homeostasis during transperitoneal or extraperitoneal laparoscopic pelvic lymphadenectomy: a real-time intraoperative comparison.

The primary goal of this study was to evaluate differences in carbon dioxide metabolism between patients undergoing transperitoneal or extraperitoneal laparoscopic pelvic lymph node dissection (L-PLND) for staging of adenocarcinoma of the prostate (CaP). Eighteen candidates undergoing L-PLND were divided between the transperitoneal (N = 12) and extraperitoneal (N = 6) approaches. End-tidal partial pressure of CO2 (PeCO2) and minute volume of expired CO2 (VCO2) were considered indicators of CO2 absorption. These two parameters were monitored intraoperatively utilizing a metabolic cart and Ohmeda Rascal-II. The cardiostimulatory effect of increasing serum CO2 and the ventilatory countermeasures used to correct the iatrogenic hypercapnia associated with CO2 insufflation were also measured. With the exception of the region of CO2 insufflation, the operative procedure and perioperative care were identical for the two groups. Preoperative patient characteristics were similar. The mean time of CO2 insufflation was 136 minutes for the transperitoneal group and 120 minutes for the extraperitoneal group. The absorption of CO2 was significantly greater and more rapid during extraperitoneal L-PLND. This may be attributable to more profound CO2 absorption from the parietal peritoneal surface compounded by subcutaneous CO2 emphysema. Disruption of microvascular and lymphatic channels during the development of the extraperitoneal working space facilitates direct CO2 absorption into the intravascular space. A minor increase in heart rate and systolic blood pressure was noted during CO2 insufflation. In all but one patient (extraperitoneal group), hypercarbia and acidemia were prevented by an increased ventilatory rate. The potential dysrhythmogenicity of hypercarbia may contraindicate the extraperitoneal approach in patients with cardiopulmonary disease.

Adenocarcinoma↗

PubMed1991

Auditory monitoring during acoustic neuroma removal.

Preservation of hearing has become attainable for patients with small acoustic neuromas. Brain-stem auditory evoked response was monitored intraoperatively in 60 patients undergoing acoustic neuroma surgery via the posterior fossa approach. The overall rate of hearing preservation was 30% in the monitored group and 20% in 60 patients who were matched for tumor size and preoperative hearing level and underwent the same surgical procedure but without intraoperative brain-stem auditory evoked response monitoring. The rate of hearing preservation was correlated with tumor size: with tumors less than or equal to 1 cm, hearing was preserved in 82% of monitored and 36% of unmonitored patients; hearing was not preserved with tumors larger than 3 cm. Intraoperative brain-stem auditory evoked response monitoring appears to have improved the preservation of hearing during removal of small tumors.

Adolescent↗

PubMed1992

Cemented versus noncemented total hip arthroplasty--embolism, hemodynamics, and intrapulmonary shunting.

Bone cement implantation syndrome is characterized by hypotension, hypoxemia, cardiac arrhythmias, cardiac arrest, or any combination of these complications. It may result from venous embolization that occurs in conjunction with intramedullary hypertension in the femur during insertion of the prosthesis in patients undergoing cemented total hip arthroplasty (THA). Intramedullary hypertension does not occur in patients undergoing noncemented THA. In this study, we sought to compare embolization between patients undergoing cemented and noncemented THA and to determine whether this state resulted in cardiorespiratory deterioration. In this prospective investigation of 35 patients undergoing elective THA, we used transesophageal echocardiography and invasive hemodynamic monitoring, and in 12 of them, we monitored distribution of pulmonary ventilation and perfusion intraoperatively. Embolization was significantly greater after insertion of the prosthesis in patients undergoing cemented than in those undergoing noncemented THA. Cemented THA was also associated with decreased cardiac output and increased pulmonary artery pressure and pulmonary vascular resistance. Increases in ventilation-perfusion mismatching, however, could not be demonstrated 30 minutes after insertion of the femoral prosthesis. Intraoperative monitoring for embolism may help physicians assess patients in whom cardiorespiratory function deteriorates during THA.

Aged↗

PubMed1990

[Monitoring of auditory brainstem response (ABR) during microvascular decompression (MVD): results in 400 cases].

In recent years, microvascular decompression (MVD) has been well established as a definitive surgical procedure in the management of hemifacial spasm (HFS) and trigeminal neuralgia (TN). With careful microsurgical technique, MVD can be performed accurately without significant morbidity. However, some incidence of postoperative hearing disturbance has been reported as one the annoying complications. In order to avoid complications of the 8th nerve, we have been using intraoperative monitoring of auditory brainstem response (ABR) for the past 5 years. This report presents the results of ABR monitoring in our personal series of 400 MVD cases. Our clinical results consist of 225 HFS and 175 TN, who underwent recording of ABR before, during and after MVD, including audiometry before and after the operation. There are 107 males and 293 females with the age ranging between 22 and 79, averaging 55 years old. Under routine general endotracheal anesthesia, the patient was placed in a lateral position and a small retromastoid opening was made. Pieces of teflon tape and fibrin glue was used to transpose, reposition and fixate the offending vessels. We used CADWELL 5200 and recorded ABR with needle electrode and click sound averaging 1500 times. ABR recordings were performed on admission, at the beginning of the operation, during nerve decompression and wound closure and at the time of discharge. The interpeak latency of waves I-V and the wave V amplitude during nerve decompression or wound closure were compared with those on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1992

Quantitative electroencephalographic monitoring during myocardial revascularization predicts postoperative disorientation and improves outcome.

We evaluated computerized quantitative electroencephalography for the intraoperative detection of cerebral dysfunction. The quantitative electroencephalogram was recorded continuously during 96 myocardial revascularizations involving hypothermic cardiopulmonary bypass using Cerebrovascular Intraoperative MONitor (CIMON) software. CIMON relies on an adaptive statistical approach to detect subtle, but clinically relevant, changes in electroencephalographic activity indicative of cerebrocortical dysfunction. Relative (percent of total) low-frequency (1.5 to 3.5 Hz) power was chosen as the single quantitative electroencephalographic descriptor because it is an established hallmark of cortical dysfunction and is surprisingly insensitive to moderate changes in body temperature and level of opioid anesthesia. Reference values for this measure were established for each patient after anesthetic induction before sternotomy. The large sample variance often seen in low-frequency power was dramatically decreased by using log-transformed data and allowing each patient to serve as his own control. Quantitative electroencephalographic changes in standard deviation units or z-scores were determined from the individualized reference self-norm. Prolonged (greater than 5 minutes) and statistically significant (greater than 3 standard deviation) focal increases in relative low-frequency power were temperature-corrected to determine a standardized cerebrocortical dysfunction time at 37 degrees C. (CDT37). In phase I (n = 48), this objective quantitative electroencephalogram-based numeric descriptor was used to predict neuropsychologic outcome. These CDT37 greater than 5-minute episodes occurred 38 times in 19 patients. The quantitative electroencephalogram-based descriptor predicted the occurrence of such disorientation (n = 14 or 29%) with a 68% false positive rate but only an 8% false negative rate. Since these intraoperative quantitative electroencephalographic episodes were often (19/38) associated with low (less than 50 mm Hg) pump pressures, phase II (n = 48) sought to correct the quantitative electroencephalographic abnormality and prevent postoperative disorientation by appropriate increases in cerebral perfusion. Although the number of episodes of quantitative electroencephalographic abnormality was similar (n = 31) in phase II, these ischemic events disappeared after prompt elevation of perfusion pressure. The phase II disorientation rate fell significantly (p less than 0.002) to 4%. Thus statistically significant increases in low-frequency electroencephalographic relative power persisting for a temperature-corrected duration of 5 minutes or more are a reliable means of alerting the surgical/anesthesia team to the presence of cerebrocortical dysfunction and provide a rational and objective basis for corrective intervention. This form of electroencephalographic monitoring appears to offer an opportunity for the timely correction of perfusion abnormalities or the administration of cerebroprotectant compounds.

Aged↗

PubMed2004

Sensory regeneration following intraoperatively verified trigeminal nerve injury.

OBJECTIVE: To follow recovery of sensory function mediated by both myelinated and unmyelinated axons in relation to the type of inferior alveolar nerve (IAN) injury. METHODS: The authors assessed the function of afferent Abeta-, Adelta-, and C-fibers of the IAN using neurophysiologic (mental nerve blink reflex, sensory nerve conduction [NCS] of the IAN) and quantitative sensory tests (QST; cold, warm, heat pain, and tactile modalities). The tests were done 2 weeks, 1, 3, 6, and 12 months postoperatively and compared to the preoperative baseline in 20 patients undergoing mandibular bilateral sagittal split osteotomy. Nineteen patients underwent intraoperative monitoring. RESULTS: In primarily demyelinating injuries (21/40 nerves), the sensory alteration and all tests normalized on the group level within the first 3 months. After partial axonal lesions (15/40 nerves), neurophysiologic and thermal QST results remained abnormal at 1-year control in a high proportion of the IAN distributions (up to 67%). At 1 year, the tactile QST was abnormal in 40%, but the NCS in 87% of the symptomatic IAN distributions. Neuropathic pain occurred in 5% of the patients, only after severe axonal damage. CONCLUSIONS: Sensory nerve conduction and thermal quantitative sensory testing showed incomplete sensory regeneration at 1 year after axonal trigeminal nerve damage. Clinical examination with tactile quantitative sensory testing was less reliable in the follow-up of sensory recovery. Sensory Abeta-, Adelta-, and C-fibers recovered function at similar rates. The trigeminal nerve does not differ from other peripheral nerves as regards susceptibility to neuropathic pain.

Action Potentials↗

PubMed2005

[Application of CWT to extract characteristic monitoring parameters during spine surgery].

It is necessary to monitor intraoperative spinal function in order to prevent spinal neurological deficit during spine surgery. This study aims to extract characteristic electrophysiological monitoring parameters during surgical treatment of scoliosis. The problem, "the monitoring parameters in time domain are of great variability and are sensitive to noise", may also be solved in this study. By use of continuous wavelet transform to analyze the intraoperative cortical somatosensory evoked potential (CSEP), three new characteristic monitoring parameters in time-frequency domain (TFD) are extracted. The results indicate that the variability of CSEP characteristic parameters in TFD is lower than the variability of those in time domain. Therefore, the TFD characteristic monitoring parameters are more stable and reliable parameters of latency and amplitude in time domain. The application of TFD monitoring parameters during spine surgery may avoid spinal injury effectively.

Adolescent↗

PubMed2006

Thoracic and thoracoabdominal aneurysm repair: is reimplantation of spinal cord arteries a waste of time?

BACKGROUND: The impact of different strategies for management of intercostal and lumbar arteries during repair of thoracic and thoracoabdominal aortic aneurysms (TAA/A) on the prevention of paraplegia remains poorly understood. METHODS: One hundred consecutive patients with intraoperative monitoring of motor evoked potentials (MEP) and somatosensory evoked potentials (SSEP) during TAA/A repair involving serial segmental artery sacrifice (October 2002 to December 2004) were reviewed. RESULTS: Operative mortality was 6%. The median intensive care unit stay was 2.5 days (IQ range: 1-4 days), and the median hospital stay 10.0 days (IQ range: 8-17 days). Potentials remained unchanged during the course of serial segmental artery sacrifice, or could be returned to baseline levels by anesthetic and blood pressure manipulation, in 99 of 100 cases. An average of 8.0 +/- 2.6 segmental artery pairs were sacrificed overall, with an average of 4.5 +/- 2.1 segmental pairs sacrificed between T7 and L1, where the artery of Adamkiewicz is presumed to arise. Postoperative paraplegia occurred in 2 patients. In 1, immediate paraplegia was precipitated by an intraoperative dissection, resulting in 6 hours of lower body ischemia. A second ambulatory patient had severe paraparesis albeit normal cerebral function after resuscitation from a respiratory arrest. CONCLUSIONS: With monitoring of MEP and SSEP, sacrifice--without reimplantation--of as many as 15 intercostal and lumbar arteries during TAA/A repair is safe, resulting in acceptably low rates of immediate and delayed paraplegia. This experience suggests that routine surgical implantation of segmental vessels is not indicated, and that, with evolving understanding of spinal cord perfusion, endovascular repair of the entire thoracic aorta should ultimately be possible without spinal cord injury.

Adult↗

PubMed1994

Vulnerability of hearing function during acoustic neuroma surgery.

Intraoperative monitoring of auditory evoked potentials reveals possible correlations between surgical maneuvers and the function of auditory structures and pathways in cerebellopontine angle surgery. Direct cochlear nerve action potentials (CNAPS) furnish realtime information on the function of the cochlea and cochlear nerve and were utilized in 14 patients undergoing removal of small (12-18 mm) unilateral acoustic tumors. The latency of the first negative component (N1) of the CNAPs proved extremely sensitive in detecting intraoperative auditory damage and was a good predictive index of postoperative auditory outcome. Evaluation of temporal and morphological CNAP patterns allowed identification of coagulation close to the cochlear nerve, drilling of the internal auditory canal and removal of the intrameatal portion of the tumor as the most critical steps in hearing preservation.

Adult↗

PubMed2006

Clinical outcomes of low-risk patients undergoing beating-heart surgery with or without pulmonary artery catheterization.

OBJECTIVE: For patients who undergo off-pump coronary artery bypass (OPCAB) surgery, pulmonary artery catheterization (PAC) has been proposed as a useful intraoperative monitoring tool. This study was designed to determine if the choice of PAC versus central venous pressure monitoring (CVP) had any effect on outcome after OPCAB. This study compared these 2 methods of hemodynamic monitoring in low-risk patients undergoing beating-heart surgery via a median sternotomy and evaluated their effect on morbidity and in-hospital mortality. DESIGN: Retrospective database and medical record review. SETTING: Tertiary care teaching hospital. PARTICIPANTS: Low-risk patients who had coronary revascularization via a median sternotomy on the beating heart. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A population of 2,414 low-risk patients who had beating-heart coronary revascularization between January 2000 and December 2003 was reviewed. Most patients (1,671 or 69.2%) received a PAC, whereas 743 (30.8%) had CVP monitoring. Risk-adjusted logistic regression analyses were performed to investigate the effect of each technique on clinical outcomes. The groups were comparable in both baseline characteristics and Parsonett's mortality risk (1.5 +/- 0.9, p = 0.58). Univariate analysis failed to show a difference in operative mortality (p = 0.76), on-pump conversion rate for completion of aortocoronary bypasses (p = 0.82), postoperative low cardiac output (p = 0.10), or prolonged inotropic agent use (p = 0.22). Similarly, in the multivariate analysis, both groups had a similar rate of conversion to an on-pump procedure for completion of coronary artery grafting (p = 0.91), intraoperative intra-aortic balloon pump use (p = 0.69), low cardiac output state (p = 0.16), or in-hospital mortality (p = 0.51). CONCLUSIONS: This single-institution, retrospective study suggests that in low-risk patients undergoing beating-heart surgery, CVP monitoring may be sufficient.

Aged↗

PubMed2003

Cost-effectiveness of intraoperative facial nerve monitoring in middle ear or mastoid surgery.

OBJECTIVES: Despite the utility of intraoperative facial nerve monitoring in reducing the risk of iatrogenic facial nerve injury during neurotologic surgery, its routine use during primary or revision surgery remains controversial. One of the major barriers to its acceptance is cost. This study evaluates the cost-effectiveness of intraoperative facial nerve monitoring during middle ear or mastoid surgery. RESEARCH DESIGN/METHODS: A simple decision analytic cost-effectiveness model and a societal approach were used to evaluate three cohorts of individuals who received (1) intraoperative facial nerve monitoring for both primary and revision middle ear or mastoid surgeries, or (2) facial nerve monitoring for revision surgeries only, or (3) no monitoring for any middle ear or mastoid surgeries. RESULTS: Our results strongly favored the use of intraoperative facial nerve monitoring in all patients undergoing middle ear or mastoid surgery, adding about $222.73 to $528.00 US dollars to the total cost. The strategy to monitor primary and revision surgeries had the greatest effectiveness and lowest cost, with an average quality-adjusted life-year (QALY) of 45.68 at an average cost of $238 US dollars. Facial nerve monitoring in revision patients only had similar QALYs (45.67) and higher costs ($292.1). Finally, the strategy not to monitor had the lowest QALY (45.65) and highest cost ($449.8). The analysis was robust across a wide range of changes in both costs and probabilities. CONCLUSIONS: Facial nerve monitoring is cost-effective, and its routine use should be adopted to reduce the risk of iatrogenic facial nerve injury during otologic surgery.

Cost-Benefit Analysis↗

PubMed2001

Carotid endarterectomy: a retrospective analysis. Microendarterectomy and transcranial Doppler ultrasound monitoring.

BACKGROUND: Analyses of the results obtained following our protocol for the surgical therapy of carotid artery stenosis is the aim of this study. METHODS: Ninety-one procedures were performed on 84 patients by the same surgical team. Indications for carotid endarterectomy (CEA) were 50-70% internal carotid artery (ICA) stenosis in 8% of the patients (100% symptomatic), 70-90% stenosis in 67% (64% symptomatic) and 90-99% ICA stenosis in 25% of our patients (33% symptomatic). Carotid shunt during arterial cross-clamp was only used in 4 cases (4.4%) following trans-cranial Doppler ultrasound (TCD) intraoperative monitoring findings. Operative microscope or surgical loupes were used for the complete removal of atheroma and the direct suture of the arteriotomy. Heparin was only antagonised in selected cases. RESULTS: No mortality and no permanent deficit related to ischemic events were present in our patients; a transient neurological deficit occurred in 1 case (1.1%). Two patients died (2.2%): 1 due to myocardial infarction and the second one to bronchopneumonia. Transient peripheral nerve deficits were noted in 2 cases. CONCLUSIONS: In order to reduce to a minimum ischemic risks during CEA, our preliminary experience advises microsurgical technique for the complete removal of the atheroma and suture, TCD evaluation of collateral reserve during cross-clamping, and the use of randomised multicenter studies guidelines for the selection of patients. More attention must also be given to postoperative care, since hemodynamic instability represents the main risk for our patients. Overnight intensive care unit (ICU) surveillance in all patients may help to avoid fatal complications.

Aged↗

PubMed1994

The effects of volatile anesthetics on the relative amplitudes and latencies of spinal and muscle potentials evoked by transcranial magnetic stimulation.

STUDY DESIGN: The effects of halothane, enflurane, or isoflurane on motor-evoked potentials via transcranial magnetic stimulation were investigated in cats. Time and dose effects on muscle potentials and spinal potentials were determined by measuring relative changes in amplitudes and latencies. METHODS: In 16 cats, muscle potentials and spinal potentials were evoked transcranially using magnetic stimulation. Potentials were recorded every 2 minutes for 10 minutes at end-tidal anesthetic concentrations of 0.25%, 0.5%, 0.75%, or 1.0%, and for 10 minutes after agents were removed. RESULTS: These anesthetics significantly attenuated the amplitude, but not the latency of muscle potentials. Effects were reversible and time and dose dependent. In contrast, these agents had little or no effect on amplitudes or latencies of spinal potentials. CONCLUSIONS: Monitoring intraoperative changes in spinal potentials may provide useful information regarding motor pathway assessment, because anesthetics have minimal effects on spinal potentials, whereas this is not so for muscle potentials.

Anesthetics, Inhalation↗

PubMed1998

Real-time intraoperative transesophageal echocardiography--how useful? Experience of 5,016 cases.

OBJECTIVE: To evaluate transesophageal echocardiography (TEE) as an intraoperative monitoring modality and to assess its safety, reliability, and overall utility in real-time use during cardiac surgery. DESIGN: Prospective, observational cohort study performed from January 1993 to June 1997. SETTING: Operating room of a tertiary care hospital for cardiology and cardiovascular surgery. PARTICIPANTS: Five thousand and sixteen adult patients with acquired heart disease, who underwent 1,356 valve procedures and 3,660 coronary artery bypass graftings (CABGs). INTERVENTIONS: All patients were monitored with radial artery and pulmonary artery catheters, along with continuous TEE monitoring with a multiplane transducer. MEASUREMENTS AND MAIN RESULTS: Prebypass imaging yielded unsuspected findings that either helped or modified the surgical plan in 158 of 1,356 valve procedures (11.65%) and in 993 of 3,660 CABGs (27.13%). There were 3,217 TEE-guided hemodynamic interventions in 944 patients (25.79%) in the CABG group and 629 in 142 patients (10.47%) in the valve group. TEE was the sole guiding factor in initiating therapy in 23.53% of events, whereas it was supportive to other monitoring modalities in 76.46% of events. Postbypass TEE identified the need for graft revision in 29 patients (0.8%), intra-aortic balloon pump (IABP) requirement in 29 patients (0.8%), and inadequate valve repair in 28 patients (2.08%). For the entire series, 38.78% of patients benefited from prebypass and 39.16% from postbypass use of TEE. There were no complications attributable to the use of TEE in the entire series. There was 87% concordance between online interpretation by a trained anesthesiologist and offline analysis by a cardiologist. CONCLUSION: Intraoperative TEE is useful in formulating the surgical plan, guiding various hemodynamic interventions, and assessing the immediate results of surgery. It is safe and the results are reliable in the hands of trained anesthesiologists.

Cardiac Surgical Procedures↗

PubMed1994

[Multiplane transesophageal echocardiography for the monitoring of cardiac surgery].

Multiplane transesophageal echocardiography (TEE) allows visualization of the heart and great vessels through an infinite number of imaging planes and improves the diagnostic capabilities of mono and biplane TEE. This study was undertaken to test whether MTEE is a useful intraoperative monitoring method during cardiac surgery. Intraoperative multiplane TEE was performed in 200 patients (mean age 56 +/- 19 years) as a part of the routine clinical care. We systematically acquired cardiac images from the gastric fundus (short and long axes of the ventricles), lower esophagus (four-chamber, two-chamber, and long axis), upper esophagus (13 views concerning the aorta, pulmonary artery, left and right atrium, systemic and pulmonary veins, coronary arteries, right ventricular outflow tract), and searched for complete views of the thoracic descending aorta. All views analyzed in the preoperative (immediately before cardiopulmonary bypass), intraoperative and postoperative phases evaluating: the angle between current and 0 degree at which each view was obtained; the success rate of each view; the usefulness of the different views in providing essential additional clinical information compared to 0 degrees and 90 degrees of the traditional biplane TEE. Most views of the heart and great vessels were visualized in oblique planes, and other views were significantly improved thanks to slight angle corrections. Multiplane TEE was particularly useful in the preoperative and postoperative phases of aortic dissection (11 cases), mitral valve repair (13 cases), left ventricular aneurysmectomy (9 cases), right atrial thrombosis (1 case), positioning of left ventricular hemopump (2 cases), mitral-aortic endocarditis (3 cases), bleeding from proximal suture of an aortic heterograft (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[The possibilities for the transcranial monitoring of the blood flow in the circle of Willis arteries during operations on the brachiocephalic arteries and in heart operations].

The paper gives the results of arterial blood flow monitoring in the circle of Willis via transcranial Doppler during 81 reparative operations on brachiocephalic arteries (including carotid endarterectomy from the internal carotid artery in 32 patients). Transcranial monitoring of blood flow supports the fact that there is a collateral reflow along the cerebral arteries during removal of the common carotid artery and that there is a relationship between the status of great arteries and arteries of Willis' circle. The paper also summaries the results of a comprehensive ultrasound study of 9 patients who have undergone reparative and plastic operations on the cardiac valves during extracorporeal circulation and general hypothermia. Blood flow was intraoperatively monitored in the arteries of the basis cerebri by using transcranial duplex scanning with colour Doppler flow mapping to evaluate not only hemodynamics, but also the embolic situation, as well as to check up how air was removed from the cardiac cavities by transesophageal echocardiography.

Blood Flow Velocity↗