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Results for “Monitoring, Intraoperative”

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At least 973 records · Page 54Linked to original sources

PubMed2000

[Monitoring of motor evoked potentials during insertion of iliosacral screws for reconstruction of pelvic fracture in two patients].

Monitoring of myogenic motor evoked potentials (MEPs) induced by transcranial electrical stimulation has become a promising tool for intraoperative monitoring. We described 2 patients who had developed significant decrease in MEP during the insertion of iliosacral screws for reconstruction of pelvic fractures. In both patients, MEPs were successfully obtained prior to the insertion under general anesthesia and partial neuromuscular blockade (propofol, ketamine, fentanyl, and nitrous oxide in oxygen: vecuronium), but reduced in association with the insertion. In one patient, they were restored by the re-insertion of screw and no new neurological deficits were observed postoperatively. However, in another patient, the decrease was not normalized and he suffered from paresis of the lower extremities after the surgery. We consider that intraoperative changes in MEPs could precisely predict postoperative motor function.

Aged↗

PubMed1982

Monitoring of sensory evoked potentials during neurosurgical operations: methods and applications.

Monitoring of sensory evoked potentials (SEPs) may help minimize the risk of neurological injury during neurosurgical operations. The author describes the current state of the art, summarizing basic principles and reviewing current clinical applications. Experience with intraoperative monitoring of auditory, somatosensory, and visual evoked potentials is presented. The pitfalls and limitations of presently available methods are discussed, with some speculation regarding future developments. Given adequate quality control in the acquisition, processing, and interpretation of electrophysiological signals, monitoring of SEPs can be a valuable adjunct to the intraoperative care of selected neurosurgical patients.

Anesthesia↗

PubMed1986

Postoperative neurological deficits may occur despite unchanged intraoperative somatosensory evoked potentials.

We describe 6 patients who demonstrated postoperative neurological deficits despite unchanged somatosensory evoked potentials during intraoperative monitoring. Although there is both experimental and clinical evidence that somatosensory evoked potentials are sensitive to some types of intraoperative mishap, the technique should be employed with an awareness of its possible limitations.

Adolescent↗

PubMed1997

[A simplified method to monitor oculomotor nerve function in midbrain surgery: recordings of compound muscle action potentials by percutaneous superior orbital electrode].

We report a simple and easily-applicable method to intraoperatively monitor the oculomotor nerve and oculomotor nucleus in the brainstem. A needle electrode is inserted into the space just beneath the superior root of the orbit. With this superior orbital electrode, evoked compound muscle action potentials from the superior rectus and the levator palpebrae superioris muscles were recorded. The nuclei for these two muscles are located caudally in the midline of the midbrain. The responses from the superior orbital electrode, therefore, give the surgeons useful intraoperative guidance during surgery for pineal region tumors and midbrain gliomas.

Action Potentials↗

PubMed2003

Intraoperative detection of traumatic coagulopathy using the activated coagulation time.

Traumatic coagulopathy manifests as a hypocoagulable state associated with hypothermia, acidosis, and coagulation factor dilution. The diagnosis must be made clinically because traditional coagulation tests are neither sensitive nor specific and take too long to be used for intraoperative monitoring. We hypothesized that the activated coagulation time (ACT) would reflect the global coagulation status of traumatized patients and would become elevated as coagulation reserves become exhausted. A prospective protocol was used to study 31 victims of major trauma who underwent immediate surgical Intervention. Victims of major head trauma were excluded and patients were selected at random over an 8-month period. At least two serial intraoperative blood samples were obtained at 15-min intervals via indwelling arterial catheters. A Hemochron model 801 coagulation monitor was used to measure the ACT. Of the 31 patients studied, 7 became clinically coagulopathic and 24 did not. The ACT measurements of coagulopathic and noncoagulopathic trauma patients were significantly different by multiple statistical comparisons. Both groups differed from normal, nontraumatized patients. The coagulopathic trauma patients had significantly elevated values when compared with other trauma patients or to normal values. We conclude that a low ACT reflects the initial hypercoagulability associated with major trauma and an elevated ACT is an objective indicator that the coagulation system reserve is near exhaustion. An elevated ACT may represent an indication for considering damage control maneuvers or more aggressive resuscitation.

Adolescent↗

PubMed1996

Intraoperative transesophageal echocardiography during liver transplantation.

OBJECTIVE: To investigate the safety, value, and impact of transesophageal echocardiography during liver transplantation. DESIGN: Retrospective. SETTING: University teaching hospital. PARTICIPANTS AND INTERVENTIONS: The medical records of 346 patients and the videotapes of 100 intraoperative transesophageal echocardiography examinations were reviewed. MEASUREMENTS AND MAIN RESULTS: Transesophageal echocardiography was indicated for intraoperative monitoring in 62 patients, 41 of whom had pertinent findings, and for diagnostic purposes in 38 patients, 14 of whom had the expected diagnosis verified. Thirty-one patients had no intraoperative findings. Information that would not have been detected intraoperatively by other means included intracardiac defects, the potential for transpulmonary air passage, valvular regurgitation, the presence or absence of ventricular dysfunction, and embolization occurring at allograft reperfusion. Unanticipated findings during the initial transesophageal echocardiography examination as well as evaluation of intraoperative events resulted in a major impact on patient management in 11% of patients. Preoperatively, 64 patients had a prothrombin time greater than 14 seconds; 56 had a platelet count less than 100,000/mm3; and 23 had esophageal varices, 7 of whom had not had variceal sclerotherapy. Two patients had a complication possibly caused by transesophageal echocardiography (sinus bradycardia and upper gastrointestinal bleeding). No patient experienced documented variceal hemorrhage, esophageal or gastric perforation, and/or oropharyngeal trauma. CONCLUSIONS: It appears that transesophageal echocardiography can be performed safely in patients undergoing liver transplantation, is efficacious in rapidly disclosing new information and monitoring during periods of hemodynamic instability, and may have a significant impact on intraoperative patient management during liver transplantation.

Adolescent↗

PubMed1985

The effects of halothane on somatosensory and flash visual evoked potentials during operations.

Intraoperative use of somatosensory evoked potentials (SEP's) to monitor intracranial aneurysm surgery and flash visual evoked potentials (F-VEP's) for parasellar surgery have been routinely employed in our clinic. We found that both EP modalities are sensitive to the changing concentration of our standard hypotensive agent, halothane. The prolongation of the N14-N20 interpeak latency to median nerve stimulation at the wrist, and prolongation of P100 latency with altered configuration of early VEP components to flash light stimulation, appear to be the results of direct pharmacological effects of the agent and not an effect of secondary hypotension. VEP is found easily abolished by halothane at a concentration of 2.0%, while the SEP is more resistant. Halothane is not ideal however when monitoring intraoperative VEP.

Adolescent↗

PubMed1982

[Effect of neuroleptanalgesia on the visual evoked potential (VEP) in man].

Visual evoked potentials (VEP) were monitored intraoperatively in 35 urological patients during modified neuroleptanalgesia. Control measurements were made in 18 awake, premedicated patients prior to induction of anesthesia. The latencies of the negative peaks (designed n1, n2, n3) increased significantly (p = 0.001) during anesthesia: n1 from 50,6 ms to 57,1 ms, n2 from 80 ms to 89,4 ms, n3 from 124,5 ms to 139,6 ms, no significant change in amplitude was seen. Changing paCO2 in the range from 20 mmHg to 50 mmHg during controlled ventilation did not affect latencies and amplitudes of visual evoked potentials (n = 10 patients). These influences of neuroleptanalgesia must be considered when recording visual evoked potentials intraoperatively during neurosurgical procedures (aneurysm-, pituar gland surgery) for monitoring optic nerve function.

Adolescent↗

PubMed1993

[Laparoscopic cholecystectomy during pregnancy].

Pregnancy has been considered an absolute contraindication to laparoscopic cholecystectomy, but recently several successful cases have been published. Two patients operated upon during the second trimester with an uneventful intra- and postoperative course and subsequent uncomplicated obstetric course are reported. The procedure requires special consideration with respect to incisions, insertion of cannula and ports, establishment and maintenance of pneumoperitoneum with a pressure of 10 mmHg, intraoperative monitoring of maternal end-tidal pCO2, perioperative foetal monitoring and choice of postoperative analgesics. The use of intraoperative cholangiography is controversial, but it should probably be avoided in pregnant patients. It is not known whether perioperative tocolytic therapy is necessary. Laparoscopic cholecystectomy is not contraindicated during pregnancy.

Adult↗

PubMed2006

[Intraoperative imaging to monitor prosthetic fixation for total hip arthroplasty].

OBJECTIVE: To explore the intraoperative imaging to monitor the prosthetic fixation for the total hip arthroplasty (THA) and to increase the accuracy of the primary THA prosthetic fixation. METHODS: From April 2000 to August 2005, 69 patients (75 hips) underwent THA monitored by the imaging (the imaged THA group, Group I), and 72 patients (78 hips) underwent THA with the standard method (the standard THA group, Group S). There were 32 72 patients (78 hips) underwent THA with the standard method (the standard THA group s in Group S). There were 32 males and 37 females in Group S. The mean ages of the patients in Group I and Group S were 62. 3 years and 60. 5 years respectively, ranging 46-75 years in Group I and 43-75 years in Group S. Preoperative diagnoses were femoral neck fractal measure (Garden III, IV ) in 23 patients (23 hips) in Group and 2 5 patients (25 hips) in Group S, acetabular dysplasia Campbell I , II) in 9 patients (10 hips) in Group I and 11 patients (13 hips) in Group S osteoarthritis in 16 patients (17 hips) in Group I and 15 patients (15 hips) in Group S, femoral head osteonecrosis (Ficat III, IV ) 15 patients (16 hips) in Group I and 17 patients (17 hips) in Group S, and rheumatoid arthritis in 6 patients (9 hips) in Group I and 4 patients (8 hips) in Group S. There were 21 hips of cement prostheses in Group I and 22 hips in Group ferative 12 hips of cementless prostheses in Group I and 11 hips in Group S, 42 hips of cement and cementless prostheses in Group I and 45 hips in Group S. Group I used the standard THA and the intraoperative X-ray monitoring the prosthetic fixation in the numerical measure of abduction angle, anteversion angle, femoral neck length, and femoral offset distance. The items compared between Group I and Group S included incisional length, intraoperative bleeding, transfusion, operative time, frequency of X-ray imaging, infection, postoperative functional recovery, and prosthetic position of postoperative X-ray imaging. RESULTS The follow-up on 62 patients in Group I and 64 patients in Group S for 6-64 months averaged 42 months revealed that there were statistically significant differences in incisional length, intraoperative bleeding. transfusion, operative time, frequency of X-ray imaging, postoperative functional recovery, prosthetic position of postoperative X-ray imaging, and the Harris score between Group I and Group S one year after operation. The results of Group I were significatnly better than those of Group S. CONCLUSION: The intraoperative X-ray imaging can increase the accuracy of the THA prosthetic fixation and reduce the incidence of THA maloperation by The X-ray imaging can also be used in county hospitals if C-arm fluoroscopy can be provided.

Aged↗

PubMed2002

Monitoring free flaps using laser-induced fluorescence of indocyanine green: a preliminary experience.

In a prospective, clinical study, the clinical utility of indocyanine green for intraoperative monitoring of free tissue transfer was evaluated. The study comprised 20 surgical patients undergoing elective microsurgical procedures. Indocyanine green angiography was performed intraoperatively, immediately after flap inset, and the operating team was blind to the fluoremetric findings. Thereafter, postoperative monitoring was done exclusively by clinical examination (color, temperature, time for recapillarization, and bleeding after puncture). Final outcome was compared with results of perioperative indocyanine (ICG)-imaging, and classified either as total flap loss, partial flap loss, or successful tissue transplantation. A total of 2 (10%) complications was recorded, and included one partial and one total flap loss. Both complications were detected by intraoperative ICG imaging. Another case of intraoperative subclinical arterial spasm at the place of microvascular anastomosis was revealed by dynamic ICG-videography. This flap did not develop postoperative complications. In conclusion, evaluation of perfusion by ICG imaging is feasible in all kinds of microsurgical flaps, irrespective of the type of tissue. Even though not meeting all the criteria of an ideal monitoring device, significant additional information can be obtained. In this study, cases with arterial spasm, venous congestion, and regional hypoperfusion were revealed by intraoperative ICG-videography. There was a strong correlation between intraoperative findings and clinical outcome.

Angiography↗

PubMed1988

Operative neurological complications resulting from thoracic and lumbar spine internal fixation.

Of 2023 patients treated for acute spinal injuries, 729 sustained acute injuries in thoracic and lumbar regions; 295 surgically treated patients were reviewed for evidence of postoperative neurological complications. Of the 295 patients, 150 were intraoperatively monitored using somatosensory-evoked potentials (SSEP). Six patients (4%) revealed intraoperative deterioration of the SSEP; however, only one of the six revealed a new postoperative neurological deficit (0.7%). The remaining 145 patients were included in the unmonitored or wake-up test group in which ten (6.9%) demonstrated new postoperative deficits. Of the 11 patients with new postoperative neurological deficits, eight patients demonstrated motor weakness, two had radiculopathy, and one had bowel-bladder incontinence. The intraoperative use of SSEP was not able to identify subtle alterations in neurological function; however, due to early warning, SSEP appears capable of preventing profound surgically induced neurological alterations. A new protocol is designed for the management of intraoperative neurological deterioration as detected by SSEP.

Adolescent↗

PubMed2003

The effect of cerebral monitoring on recovery after general anesthesia: a comparison of the auditory evoked potential and bispectral index devices with standard clinical practice.

UNLABELLED: The use of cerebral monitoring may improve the ability of anesthesiologists to titrate anesthetic drugs. However, there is controversy regarding the impact of the alleged anesthetic-sparing effects of cerebral monitoring on the recovery process and patient outcome. We designed this prospective double-blinded, sham-controlled study to evaluate the impact of intraoperative monitoring with the electroencephalogram bispectral index (BIS) or auditory evoked potential (AEP) device on the usage of desflurane and the time to discharge from the recovery room, as well as on patient satisfaction with their anesthetic experience and recovery. Ninety healthy patients undergoing laparoscopic general surgery procedures using a standardized anesthetic technique were randomly assigned to one of three monitoring groups: standard clinical practice (control), BIS-guided, or AEP-guided. Both the BIS and AEP monitors were connected to all patients before induction of general anesthesia. In the control group, the anesthesiologists were not permitted to observe the BIS or AEP index values during the intraoperative period. In the BIS-guided group, the volatile anesthetic was titrated to maintain a BIS value in the range of 45-55. In the AEP-guided group, the targeted AEP index range was 15-20. The BIS and AEP indices, as well as end-tidal desflurane concentration, were recorded at 3-5 min intervals. Recovery times to awakening, tracheal extubation, fast-track score >or=12, and postanesthesia care unit (PACU) discharge criteria were recorded at 1-10 min intervals. In addition, patient satisfaction with anesthesia and quality of recovery were evaluated on 100- and 18-point scales, respectively, at 24 h after surgery. The AEP- and BIS-guided groups were administered significantly smaller average end-tidal desflurane concentrations than the control group (3.8 +/- 0.9 and 3.9 +/- 0.6 versus 4.7 +/- 1.7, respectively) (P < 0.01). Although the emergence times to eye opening, tracheal extubation, and obeying commands were consistently shorter in the AEP and BIS groups (6 +/- 4 and 6 +/- 5 versus 8 +/- 8 min; 6 +/- 5 and 6 +/- 4 versus 11 +/- 10 min; and 8 +/- 4 and 7 +/- 4 versus 12 +/- 9 min, respectively), only the extubation times were significantly different from the control group (P < 0.05). More importantly, the length of the PACU stay was significantly shorter in both the AEP- and BIS-guided groups (79 +/- 43 and 80 +/- 47 versus 108 +/- 58 min, respectively) (P < 0.05). The patients' quality of recovery was also significantly higher in the two monitored groups (15 +/- 2 versus 13 +/- 3 in the control group, P < 0.05). We concluded that cerebral monitoring with either the BIS or AEP devices reduced the maintenance anesthetic (desflurane) requirement, resulting in a shorter length of stay in the PACU and improved quality of recovery after laparoscopic surgery. However, there were no significant outcome differences between the two cerebral monitored groups. IMPLICATIONS: Compared with standard monitoring practices, use of an auditory evoked potential or bispectral index monitor to titrate the volatile anesthetic led to a significant reduction in the anesthetic requirement. The anesthetic-sparing effect of cerebral monitoring resulted in a shorter postanesthesia care unit stay and improved quality of recovery from the patient's perspective.

Adult↗

PubMed1999

[Utility of an infrared ear thermometer as an intraoperative core temperature monitor].

We investigated the utility of an infrared ear thermometer (M 10, Terumo) as an intraoperative core temperature monitor. Temperatures of the axilla and inner ear were measured before and after anesthesia. Bladder, rectal, and forehead deep temperatures were continuously measured using a core temperature monitor (CTM-205, Terumo) during anesthesia. At the same time, the temperature of the inner ear was measured 4 times every 15 minutes (twice from cephalad and twice from caudal directions). There were no significant differences in the measured inner ear temperatures, either between directions of measurement or between the 1st and 2nd measurements. The inner ear temperature showed a close correlation with rectal, bladder, forehead deep, and axillary temperatures (r = 0.72-0.79, P < 0.01). The smallest temperature difference in this study was found to be that between the inner ear and forehead deep temperatures (-0.10), and the limit of agreement between these temperatures was also the smallest (0.81). In conclusion, we recommended the use of an infrared ear thermometer as an intraoperative core temperature monitor, especially in lower abdominal surgery, in which neither rectal nor bladder temperature monitoring is reliable.

Anesthesia, General↗

PubMed2006

Continuous intraoperative facial nerve monitoring in predicting postoperative injury during parotidectomy.

OBJECTIVES/HYPOTHESIS: To assess whether the use of continuous intraoperative facial nerve monitoring correlates to postoperative facial nerve injury during parotidectomy. STUDY DESIGN: A retrospective analysis. METHODS: Forty-five consecutive parotidectomies were performed using an electromyograph (EMG)-based intraoperative facial nerve monitor. Of those, 37 had complete data for analysis. Intraoperative findings and final interpretation of the EMGs were analyzed by a senior neurologist and neurophysiologist. All patients were analyzed, including those with preoperative weakness and facial nerve sacrifice. RESULTS: The overall incidence of facial paralysis (House-Brackmann scale > 1) was 43% for temporary and 22% for permanent deficits. This includes an 11% incidence of preoperative weakness and 14% with intraoperative sacrifice. An abnormal EMG occurred in only 16% of cases and was not significantly associated with permanent or temporary facial nerve paralysis (chi, P < 1.0; Fisher's exact P < .68). Of the eight patients with permanent paralysis, only two had abnormalities on the facial nerve monitor. Also, only one of five patients with intraoperative sacrifice of the facial nerve had an abnormal EMG. Factors significantly associated with the incidence of facial paralysis include malignancy, advanced age, extent of parotidectomy, and dissection beyond the parotid gland (chi and Fisher's, P < .05). CONCLUSIONS: The results suggest that abnormalities on the intraoperative continuous facial nerve monitor during parotidectomy do not predict facial nerve injury. The incidence of permanent and temporary facial nerve paralysis compare favorably with the literature given that this study includes patients with revision surgery, intraoperative sacrifice, and preoperative paralysis. Standard of care implications will be discussed.

Chi-Square Distribution↗

PubMed2003

Transcervical endoscopic-assisted mediastinal parathyroidectomy with intraoperative parathyroid hormone monitoring.

Ectopic mediastinal parathyroid adenomas are rare lesions that typically necessitate either median sternotomy or thoracotomy. More recently, video-assisted thoracoscopy has been used to excise mediastinal parathyroid adenomas. Herein we describe a novel technique in which we used a minimally invasive transcervical endoscopic-assisted approach to excise an anterior mediastinal parathyroid adenoma in a young man with a history of spontaneous pneumothorax. Intraoperative parathormone monitoring confirmed the excision of all hypersecreting parathyroid tissue, thereby obviating the need for a conventional neck exploration.

Adenoma↗

PubMed1988

Cortical evoked potential monitoring during spinal surgery: sensitivity, specificity, reliability, and criteria for alarm.

Cortical somatosensory evoked potentials (EP) were used for intraoperative monitoring of spinal cord integrity during 158 consecutive cases involving surgical correction of spinal deformities. Using a monitoring technique designed to optimize recording, 88% of patients had stable EP results at the time of spinal manipulation. However, five of six patients with preexistent neurological deficits did not have stable EPs. A persistent EP amplitude attenuation of greater than or equal to 40% was a sensitive and specific criterion for alarm. Seven patients had transient attenuations of greater than or equal to 40% after distraction that recovered, so that the distraction instrumentation could be left in place. Overall, this particular cortical somatosensory EP recording technique appears to be appropriate for clinical monitoring. Other recording techniques may be necessary for patients with preexisting neurological deficits.

Adolescent↗

PubMed1985

Neuromonitoring during interventional neuroradiology.

The neurophysiologic monitoring of interventional neuroradiologic procedures is a new field of intraoperative monitoring. Interventional neuroradiology makes use of different diagnostic or therapeutic catheterization techniques in both cerebral and spinal cord arteries. Both procedures can be made more secure by monitoring of EEG or evoked potentials. Using the advantages of the different catheter techniques, such as series of balloon occlusions or injections of drugs or contrast dye, the neuroradiologist and the neurophysiologist are able to plan and test the next steps of an interventional maneuver. The results and implications of neuromonitoring during occluding maneuvers of the internal carotid artery, during local fibrinolytic therapy, during embolization procedures of cerebral or spinal arteries, malformations, or tumors, and during drug application are discussed and illustrated.

Angioplasty, Balloon↗