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Results for “Monitoring, Intraoperative”

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PubMed1994

Somatosensory evoked potentials during exclusion and reperfusion of critical aortic segments in thoracoabdominal aortic aneurysm surgery.

Forty-three patients undergoing repair of a thoracoabdominal aortic aneurysm were monitored to evaluate spinal cord ischemia, as evidenced by somatosensory evoked potentials (SEPs). All patients were operated on using left heart bypass. In 34 patients (80%), staged clamping was used. Except for cerebrospinal fluid (CSF) drainage in 15 patients (35%), no other protective measures to preserve spinal cord function were used. The overall incidence of immediate onset paraplegia was 7%, and of immediate onset paraparesis was 5%; neither was limited only to those patients in whom potentials were lost. In 18 patients (42%), no change in the evoked potentials occurred; one of these patients (5%) awoke paraplegic after operation, and two others had a delayed onset paraplegia. In 13 patients (30%), evoked potentials were lost despite adequate perfusion; in 12 of them, potentials returned gradually, with one immediate paraplegia (8%), and in one potentials did not return at all, with subsequent immediate paraplegia (100%). In 12 patients (28%), evoked potentials decreased without being lost completely, and then recovered; in this group there were no immediate paraplegias. No relationship could be demonstrated between the extinction time, the recovery time, or the duration of loss of evoked potentials with postoperative neurological outcome. Intraoperative monitoring of SEPs is a good indicator of spinal cord ischemia, although we found a 5% incidence of false negatives. SEP monitoring offers an improvement in surgical strategy, and allows safer operations for thoracoabdominal aneurysms.

Aged↗

PubMed2002

Transcranial electrical stimulation: significance of fast versus slow charge delivery for intra-operative monitoring.

OBJECTIVES: Motor-evoked potentials (MEP) for intra-operative monitoring due to fast charge (fc: 1.0 Coulomb/s) and slow charge (sc: 0.1Coulomb/s) delivery for multipulse transcranial electrical stimulation (TES) were compared. METHODS: MEPs due to fc (n=162) and sc stimulation (n=182) were performed in parallel in a prospective study. The fc stimulation technique is characterized by an increased steepness of charge delivery with consequent reduction of stimulus duration of 50 micros compared to 500 micros in sc stimulation. Stimulation charges (C=Coulomb) and MEP parameters during spine surgery were analyzed. RESULTS: MEPs were successfully recorded in 15/18 patients under total intravenous anesthesia. The mean charge to induce intra-operative MEPs (stimulation threshold) was significantly less in fc (0.195 mC) as compared to sc stimulation (0.298 mC). With both stimulation techniques, in all patients without impairment of motor function, MEPs could be recorded and no technique was superior with respect to successful stimulation. The mean MEP latencies, amplitudes and the extent of intra-individual variation of MEP parameters during surgery (shift of latency less than 10%, variability of amplitude less than 50%) were not different with both stimulation techniques. CONCLUSIONS: TES with either fc or sc stimulation can be used reliably for intraoperative monitoring. Fc and sc stimulation are comparable with respect to feasibility, intra-individual variability and mean parameters of MEP responses. However, fc stimulation provides a higher stimulation efficiency and requires about 35% less total charge for MEP monitoring.

Adolescent↗

PubMed1990

Concurrent monitoring of brainstem auditory and somatosensory evoked potentials during carotid endarterectomy.

Intraoperative management of a 68-year-old man with a 3-month history of presyncopal attacks presenting for left carotid endarterectomy is reported. Preoperative angiograms revealed that the patient had a 90% stenosis of his left internal carotid artery and a 35% stenosis of right internal carotid artery, absent posterior communicating arteries, a totally occluded left vertebral artery, and a right vertebral artery that became compressed upon turning his head to the right, often precipitating the presyncopal attacks. The surgical procedure was managed with intraoperative monitoring of both brainstem auditory and somatosensory evoked potentials. The patient had an uneventful outcome. The anesthetic management is discussed.

Journal Article↗

PubMed1996

[Changes in somatosensory evoked potentials after sevoflurane and isoflurane. A randomized phase III study].

Monitoring of somatosensory evoked potentials (SEP) is used to identify critical phases of cerebral ischaemia by means of characteristic changes in the signal patterns. A correct interpretation of the results is possible, however, only if the influence of drugs that act on the central nervous system is known. We were able to show that volatile anaesthetics have an impact on latencies and stimulus amplitudes. In this study, we examined the influence of sevoflurane as compared with isoflurane on the conduction of SEP by the median nerve at various concentrations. In addition, we determined how the addition of nitrous oxide (N2O) influenced the stimulus response of median-nerve SEP. Both isoflurane and sevoflurane caused a dose-dependent increase in latency of the primary cortical complex, while the influence on the cervical components of the SEP with respect to increased latency was only slight. No significant difference was found between both study groups. Under the influence of N2O, there were marked reductions in amplitude of the cortical stimulus response. Thus, it can be recommended that supplementation with N2O should be avoided in the presence of low initial amplitudes. Based on our results, the use of isoflurane and sevoflurane concentrations up to 1.0 MAC seems to be compatible with intraoperative monitoring of SEP.

Anesthetics, Inhalation↗

PubMed2002

Corticospinal volleys and compound muscle action potentials produced by repetitive transcranial stimulation during spinal surgery.

OBJECTIVES: To report our experience with neurophysiological monitoring of corticospinal function using compound muscle action potentials (CMAPs) produced by repetitive transcranial electrical stimulation in a large series of patients, after defining optimal stimulus parameters in a small group of patients. METHODS: In 100 patients undergoing spinal surgery, corticospinal volleys were recorded using epidural electrodes, or CMAPs were recorded from innervated muscles, or both techniques were used to monitor spinal cord function. In subsets of patients, stimulus parameters were varied to determine the optimal parameters for CMAP recordings, using the corticospinal volleys to guide the initial choice. RESULTS: Recordings of corticospinal volleys indicated that less energy was delivered to the cortex if the duration of each stimulus in the stimulus train was brief (e.g. 50 micros) and that there was attenuation of D and I waves in the corticospinal volley when the interstimulus interval in the train was <5 ms. An interstimulus interval of 5 ms proved significantly more effective than an interstimulus interval of 2 ms in evoking CMAPs, but resulted in a more complex, dispersed electromyographic (EMG) potential. The superiority of the 5 ms interval did not depend on stimulus intensity or the existence of pre-existing neurological deficit. Using trains of 5 pulses of duration 50 micros, interstimulus interval 5 ms and intensity 500 V, satisfactory CMAPs could be recorded in 55 of 82 patients, significantly less often in neurologically impaired patients than in neurologically normal subjects. Epidural recordings of the corticospinal volley were obtained in 61 of 69 patients, again more often in neurologically normal subjects. CONCLUSIONS: When epidural recordings can be made, direct recordings of corticospinal activity are probably more reliable than recordings of CMAPs. However, epidural recordings are not suitable under all circumstances, and the ability to record CMAPs reliably represents an advance in intraoperative monitoring. Under the anaesthetic conditions used in the present study, the optimal stimulus parameters consist of a train of 5 stimuli of 50 micros duration at an interstimulus interval of 5 ms and an intensity of 500 V.

Action Potentials↗

PubMed1994

Transcranial magnetic evoked potentials used to monitor the spinal cord during neuroradiologic angiography of the spine.

A current topic in intraoperative monitoring of the spinal cord is the inability of the somatosensory evoked potentials (SSEP) to adequately document anterior spinal cord function. Transcranial magnetic stimulation (TMS) of the cortex for assessing corticospinal (efferent) pathways is a developing modality. The authors demonstrate a potential application of TMS as a monitoring medium for use in the neuroradiology suite. Limitations of intraoperative applications of cortical magnetic stimulation associated with cortical suppression are caused by anesthetics and neuromuscular blockers. These limitations generally are not an issue in the neuroradiology suite. In this report, motor improvement was correctly predicted by magnetic evoked potential amplitudes, whereas an SSEP remained unchanged during neuroradiologic angiography.

Arteriovenous Malformations↗

PubMedDate not supplied

Monitoring regional cerebral oxygen saturation using near-infrared spectroscopy during pulsatile hypothermic cardiopulmonary bypass in a neonatal piglet model.

Impairment of cerebral oxygenation in neonates and infants after hypothermic nonpulsatile cardiopulmonary bypass (CPB) support is well documented. The objectives of this study were: 1) using a neonatal piglet model to continuously monitor the regional cerebral oxygen saturation (rSO2) by near-infrared spectroscopy during pulsatile hypothermic CPB; and 2) to quantify the pulsatile flow in terms of energy equivalent pressure (EEP). After initiation of CPB, all piglets (n = 5) were subjected to 15 minutes of core cooling, reducing the rectal temperature to 25 degrees C, followed by 60 minutes of hypothermic CPB, then 10 minutes of cold reperfusion, and 30 minutes of rewarming. During CPB, mean arterial pressures (MAPs) and pump flow rates were maintained at 40-45 mm Hg and 150 ml/kg/min, respectively. During normothermic CPB, the rSO2 was significantly increased, compared with the pre-CPB level (56.8 +/- 5.2% vs. 41.8 +/- 5.5%, p < 0.01). At the end of cooling, the rSO2 level was 76.8 +/- 8.6% (p < 0.001 vs. pre-CPB). After 60 minutes of hypothermic CPB and 30 minutes of rewarming, the rSO2 level was decreased to 38.6 +/- 4.2%, which was not significantly different compared with the pre-CPB level. The average increase in pressure (from MAP to EEP) was 5 +/- 1%, and the average increase in extracorporeal circuit pressure (from ECCP to EEP) was 13 +/- 2%. This extra pressure may help to provide better regional cerebral oxygen saturation. During pulsatile CPB, there was no rSO2 deficiency in this high flow model. Near-infrared spectroscopy responded well to changes in rSO2 during different stages of these experiments and might be a helpful tool for intraoperative monitoring.

Animals↗

PubMed1999

Vagal nerve monitoring in surgery of the skull base: a comparison of efficacy of three techniques.

OBJECTIVE: To compare three techniques of monitoring the vagal nerve during skull base surgery using laryngeal electromyography (EMG). STUDY DESIGN: Prospective comparison. SETTING: California Ear Institute at Stanford, tertiary referral center. PATIENTS: Seventeen consecutive patients undergoing lateral skull base surgery potentially placing the vagal nerve at risk. INTERVENTIONS: Each patient was simultaneously monitored intraoperatively with three separate EMG techniques: 1) endolaryngeal surface electrodes mounted on an endotracheal tube (ETT) (Xomed Surgical Products, Inc., Jacksonville, FL); 2) endoscopically placed endolaryngeal thyroarytenoid intramuscular hookwire electrodes; and 3) percutaneously placed cricothyroid intramuscular hookwire electrodes. MAIN OUTCOME MEASURES: Sensitivity, reliability, response magnitude, incidence of false-positive responses, and complications were recorded. Preoperative and postoperative vagal nerve function was noted. RESULTS: The study was completed in 13 patients. The endolaryngeal intramuscular electrode technique responded at the lowest current stimulus (mean, 0.073 mA) with the highest average magnitude response. It responded in 100% of patients. The percutaneous intramuscular technique was similarly sensitive (mean stimulus, 0.089 mA) with a large average magnitude response but was much less reliable (responded in 69.2% of patients). The Xomed ETT was less sensitive (mean stimulus, 0.120 mA), had the lowest average magnitude response, and demonstrated medium reliability (responded in 76.9% of patients). The ETT exhibited the lowest incidence of spontaneous false-positive EMG activity. No complications were noted, and vagal nerve function was not compromised in any patient. CONCLUSIONS: Although the Xomed ETT exhibited ease of placement and a low false-positive response rate, it demonstrated lowest sensitivity compared with electrodes placed intramuscularly. The percutaneous intramuscular electrode technique was the least reliable, likely related to blind insertion, making it a less-desirable technique. Because of its highest relative sensitivity and reliability, the endolaryngeal intramuscular electrode technique of vagal monitoring is best supported by this study.

Adult↗

PubMed2003

Loss of SSEP during sitting craniotomy.

A 54-year-old woman with a past medical history of asthma and depression presented with right side hearing loss and ataxia. She was scheduled for a sitting craniotomy for cerebellopontine angle tumor resection. Somatosensory evoked potential, brainstem auditory evoked response, and facial nerve EMG were monitored intraoperatively. Approximately 30 minutes into the case, there was an episode of air embolism, which resolved after the source was identified and treated. Near the conclusion of the case, there was an abrupt loss of the right cortical somatosensory evoked potential signal, which never returned to baseline. A postoperative CT scan showed a substantial amount of subarachnoid air and intraventricular air in the frontal and temporal regions. The patient awakened in the ICU with no new neurologic deficit besides preoperative hearing loss on the right side. Despite the high specificity of somatosensory evoked potential change associated with postoperative neurodeficit when the change never returns to the baseline, there was no postoperative neurologic deficit in this patient. This case indicates the false-positive somatosensory evoked potentials caused by pneumocephalus in the sitting position.

Cerebellar Neoplasms↗

PubMed1994

Stimulus-evoked EMG monitoring during transpedicular lumbosacral spine instrumentation. Initial clinical results.

OBJECTIVES: The authors developed and evaluated an electrophysiologic method for minimizing the risk of nerve root trauma associated with the placement of pedicle screws during transpedicular lumbosacral fixation in humans. SUMMARY OF BACKGROUND DATA: Various methods have been evaluated to reduce the high complication rates associated with lumbosacral transpedicular fixation, but none are without significant limitations or drawbacks. Using a pig model, we previously developed a technique for assessing, by electrophysiologic means, the potential risk associated with placement of a screw at a given site. In this report, the authors describe their experience with this technique in patients. METHODS: Electromyogram (EMG) was monitored from eight lower extremity muscles bilaterally. Square-wave electrical shocks (200 microseconds, 7 mA) were delivered through the instruments used to form and evaluate each pedicle hole, and through the screw itself if placement was deemed safe. Provided that the instruments used (e.g., awl, tap, probe) do not exit from bone in any direction below the entry point, the resistance of bone to the 7 mA stimulus intensity is high enough such that no nerve roots are stimulated, and the EMG traces remain flat. Conversely if EMG is evoked, it warns of a potential perforation in a pedicle wall or in the anterior body. RESULTS: The authors evaluated this technique in 18 patients in whom a total of 102 screws were placed. Based on results of electrophysiologic and palpatory evaluation, 68% of the screws were placed in a satisfactory manner. Electrophysiologic evidence of a perforation, which could not be confirmed by palpation or visualization, was seen in another 13% of this total. The remaining 19% of screw placements involved sites where a defect was missed originally by palpation alone, but was located based on electrophysiological testing combined with palpation and visualization (11%), and where a perforation was initially palpated (8%). There was no postoperative morbidity associated with malpositioned screws. CONCLUSIONS: Our results indicate that the technique is sensitive and, based on early clinical results, reliable in the detection of perforations in pedicle screw placement. Moreover, the method is inexpensive, rapid, and easily implemented into a standard intraoperative monitoring protocol.

Adult↗

PubMed2006

Non-invasive prediction of fluid responsiveness during major hepatic surgery.

BACKGROUND: The aim of this study was to evaluate potential predictors of fluid responsiveness obtained during major hepatic surgery. The predictors studied were invasive monitoring of intravascular pressures (radial and pulmonary artery catheter), including direct measurement of respiratory variation in arterial pulse pressure (PPVart), transoesophageal echocardiography (TOE), and non-invasive estimates of PPVart from the infrared photoplethysmography waveform from the Finapres (PPVfina) and the pulse oximetry waveform (PPVsat). METHODS: We conducted a prospective study of 54 fluid challenges (250 ml colloid) given for haemodynamic instability in eight patients undergoing hepatic resection. Fluid responsiveness was defined as an increase in stroke volume index (SVI) >or=10%. The following variables were recorded before each fluid challenge: right atrial pressure (RAP), pulmonary artery occlusion pressure (PAOP), PPVart, PPVfina, PPVsat, and the TOE-derived variables left ventricular end-diastolic area index (LVEDAI), early/late (E/A) diastolic filling wave ratio, deceleration time of the E wave (MDT) of mitral flow and the systolic fraction of the pulmonary venous flow (SF). RESULTS: Only PPVfina, PPVart (both P<0.001), PPVsat (P=0.02), LVEDAI and MDT (both P=0.04) were different in responder vs non-responder fluid challenges. The areas under the receiver operating characteristic (ROC) curves were 0.81 (PPVfina), 0.79 (PPVart), 0.70 (LVEDAI), 0.68 (PPVsat and MDT), 0.63 (RAP), 0.62 (E/A), 0.55 (PAOP) and 0.42 (SF). The areas under the ROC curves for RAP, E/A, PAOP and SF were significantly less than that for PPVfina (P<0.05 in each case). Only PPVart (r=0.59, P=0.0001) and PPVfina (r=0.56, P=0.0001) correlated with the fluid challenge-induced changes in SVI. CONCLUSIONS: PPVart and PPVfina predict fluid responsiveness during major hepatic surgery. This suggests that intraoperative monitoring of fluid responsiveness may be implemented simply and non-invasively.

Aged↗

PubMed1999

Variability of somatosensory-evoked potentials in different stages of scoliosis surgery.

STUDY DESIGN: A comparison of the latencies and amplitudes of the somatosensory-evoked potential in different stages of scoliosis surgery. OBJECTIVES: To investigate the normal variability of the somatosensory-evoked potential at different stages of scoliosis surgery and to improve the reliability of spinal cord monitoring. SUMMARY OF BACKGROUND DATA: False alarms in intra-operative spinal cord monitoring have been reported when the somatosensory-evoked potential measured before skin incision was used as the reference baseline value. However, the normal variability during different stages of surgery and the specificity of somatosensory-evoked potential is not well documented. METHODS: The somatosensory-evoked potential of 90 patients who underwent surgical correction for idiopathic scoliosis was monitored intraoperatively, with stimuli applied to the posterior tibial nerve. The amplitudes and latencies of the somatosensory-evoked potential were recorded over Cz'-Fz and Cv-Fz. The values of latencies and amplitudes and their percentage variabilities were analyzed. RESULTS: The values of latencies and their percentage variabilities did not differ significantly from each other in different stages of surgery. The values of amplitudes between different stages showed statistically significant differences. In particular, the amplitude of the somatosensory-evoked potential was found to be significantly decreased after exposure of the spine when compared with the amplitude before skin incision. CONCLUSION: Some variability in latencies and amplitudes between different stages of scoliosis surgery is normal. These results suggest that the somatosensory-evoked potential when the spine is exposed may be used as the reference baseline to determine whether somatosensory-evoked potentials are subnormal at the subsequent stages of surgery.

Adolescent↗

PubMed1997

A rare case of a somatosensory evoked potentials recording during cardiopulmonary resuscitation.

BACKGROUND: Neuronal damage is a possible complication of cardiac surgery. To reduce the potential risk of postoperative neurological deficit, the functional state of affected central nervous system pathways is monitored intraoperatively by recording evoked potentials (EPs). Apart from animal research, there is little clinical evidence of EPs recording during cardiac arrest and cardio-pulmonary resuscitation (CPR). METHODS: Both scalp (SCEPs) and spinal (SSEPs) short-latency somatosensory EPs were recorded as the response to the electrical stimulation of the right median nerve during mitral valve replacement surgery. Evoked potentials were recorded before, during, and after sudden ventricular fibrillation followed by CPR. RESULTS: Preoperative control recordings of both SCEPs and SSEPs were in the normal ranges. During the first 4 min of cardiac arrest and resuscitation, all SCEPs waves disappeared, while the spinal component of the SSEPs was still recognizable. After CPR, all waves of both EPs recordings recovered completely. The patient woke from anesthesia without neurological deficits. CONCLUSIONS: As expected, scalp-recorded EPs are more sensitive to the cardiac arrest than spinal EPs. Rapid and almost complete recovery of postoperative EPs, namely SCEPs, correlated well with normal neurological recovery.

Aged↗

PubMed1994

Patterns of coagulopathy during liver transplantation: experience with the first 75 cases using thrombelastography.

Using both conventional laboratory clotting profile and thrombelastography, coagulation status was monitored intraoperatively during liver transplantation in the first 75 cases performed at the Austin Hospital between June 1988 and October 1992. Superimposed on a baseline coagulopathy due to liver disease is a specific pattern of coagulation disturbance which occurs during a liver transplant. Fibrinolysis occurs in the anhepatic stage, worsens with early reperfusion and then spontaneously resolves. In addition reperfusion is associated with a transient clotting defect. If blood loss is excessive, coagulopathy due to massive transfusion may compound the situation. Thrombelastography is a measurement technique allowing rapid on-site assessment of functional clotting status. It is particularly useful in liver transplant surgery. In combination with clinical bleeding assessment it facilitates selective use of component therapy (fresh frozen plasma, platelets and cryoprecipitate) and specific drug treatment only when it is appropriate. It also acts as a liver function test, being especially useful in assessing the graft after reperfusion.

Blood Coagulation↗

PubMed1996

Intra-operative monitoring by facial electromyographic responses during microvascular decompressive surgery for hemifacial spasm.

The facial electromyographic response was monitored intraoperatively in 40 patients with hemifacial spasm who were operated on by microvascular decompression of the facial nerve. All 40 patients showed an abnormal facial electromyographic response (lateral spread response) with a latency of about 10 msec after stimulation. The abnormal response resolved before decompression in 22, resolved immediately with decompression in 16, and failed to resolve in two. Of the 38 patients in whom the abnormal response disappeared during surgery, 36 were postoperatively free from hemifacial spasm and two had mild hemifacial spasm. The two patients in whom the lateral spread response did not disappear during surgery showed persistent hemifacial spasm. In conclusion. Disappearance of the lateral spread response during surgery correlated with the absence of hemifacial spasm in the early postoperative period. The prognosis of hemifacial spasm was good in cases in whom the lateral spread response disappeared. Therefore, the authors think that intra-operative facial electromyography is very useful in assessing the efficacy of microvascular decompression and in predicting the prognosis of hemifacial spasm.

Adult↗

PubMed1996

Computerized vectorcardiography for improved perioperative cardiac monitoring in vascular surgery.

BACKGROUND: Postoperative cardiac complications occur frequently after noncardiac operations in high-risk patients. Routine cardiac monitoring is usually done by electrocardiographic (ECG) methods. The present analysis shows that computerized vectorcardiography (VCG) is superior to traditional ECG monitoring in predicting postoperative cardiac complications. STUDY DESIGN: Thirty-eight patients scheduled for abdominal aortic operations were monitored intraoperatively and for 48 hours postoperatively using VCG. These data were analyzed in a blinded fashion, and compared to cardiac outcome and regularly calculated 12-lead ECGs. RESULTS: Thirteen patients suffered from cardiac events: myocardial infarction (n = 3), cardiac death (n = 1), recurrent myocardial ischemia (n = 1), arrhythmias (n = 2), congestive heart failure (n = 2), and arrhythmias combined with congestive heart failure (n = 4). Thirty of 38 patients had ischemia recorded on their VCG, including all 13 patients with cardiac events. Only seven of the 13 patients had ischemic changes on the V5-lead alone and ten on the three leads II, V4, V5, yielding a sensitivity of 54 percent (V5), 77 percent (II, V4, V5) and 100 percent (VCG). Signs of ischemia appeared 400 +/- 690 (mean plus or minus standard deviation) minutes earlier (median 78 minutes, with a range of zero to 2,284 minutes), and never later on the VCG compared to the three leads II, V4, V5. CONCLUSIONS: Vectorcardiography in this risk group shows increased sensitivity in predicting perioperative cardiac complications and earlier ischemia detection than the most sensitive scalar leads. Vectorcardiography substantially improves the possibility of earlier intervention, potentially reducing the incidence of postoperative cardiac complications.

Aged↗

PubMed1994

[Monitoring of electroencephalogram during the operation under the extracorporeal circulation].

Generally speaking, it is difficult to know the occurrence of brain complication until the patient becomes awake from anesthesia. But if we can detect the occurrence of of brain complication during the operation, we can start its therapy even during the operation. In order to detect the occurrence of brain complication during the operation under extracorporeal circulation (ECC), we monitored intraoperative electroencephalogram (EEG). Since June 1992, forty-two patients were operated on using ECC. Usual ECC was applied in 39 cases (Group-A), and circulatory arrest with retrograde cerebral perfusion was applied in remaining three cases (Group-B). We studied the amplitude of EEG using actual value (by Fujimori method), and compressed EEG acquired by slow-paper-feed recording. In terms of the frequency of EEG, we studied compressed spectral array (CSA). In Group-A, there was no brain complication identified after operation. Actual values of amplitude were 23 +/- 4.0 microV (before ECC), 19 +/- 4.0 microV (during ECC), 23 +/- 4.9 microV (after ECC). There was a significant decrease (p < 0.001) of amplitude during ECC compared with that before ECC. The ratio of amplitude during ECC to that before ECC (D/B ratio) was 0.82 +/- 0.16. The ratio of amplitude after ECC to that before ECC (A/B ratio) was 1.01 +/- 0.15. According to compressed EEG, it was observed that the amplitude changes following the up-down of esophageal temperature. In CSA, influence of esophageal temperature on the power spectrum of alpha and delta wave band was recognized. In Group-B, there was one brain complication identified after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2004

Intraoperative parathyroid hormone monitoring.

The principles of minimally invasive parathyroidectomy include the successful preoperative localization of a solitary adenoma, a targeted operative approach that does not disturb the normal parathyroid glands, and intraoperative confirmation of excision of all hypersecreting parathyroid tissue. By providing real-time feedback to the surgical team, the rapid PTH assay allows surgeons to assess the completeness of parathyroid resection without visualizing all the parathyroid glands. Intraoperative PTH monitoring facilitates the use of local anesthesia, decreases the duration of surgery, and allows ambulatory surgery in most patients. This article reviews current recommendations and controversies surrounding the use of intraoperative PTH monitoring during parathyroidectomy.

Adenoma↗