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Results for “Monitoring, Intraoperative”

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PubMed1987

[Anesthesia for congenital diaphragmatic hernia].

Hypoplasia of the lungs is the cause of the high mortality of newborns with diaphragmatic hernia. Survival depends mainly on the development of the contralateral lung. Eighty percent of diaphragmatic hernias are postolateral hernias of the left side. The most serious postoperative complication is a relapse into fetal circulation with increased pulmonary vascular resistance and right-to-left shunting (Fig. 2). The clinical signs of diaphragmatic hernia are cyanosis and tachypnea. Intermittent suction via a nasogastric tube and early intubation without mask ventilation should be performed. The inspiratory pressure should not exceed 25 cm H2O to minimize the risk of pneumothorax. Survival of the baby is unlikely if the initial blood gas analysis shows pH less than 7.10, pO2 less than 50 mmHg, and pCO2 greater than 65 mmHg. Hypothermia should be strictly avoided because it leads to increased oxygen consumption. Intraoperative monitoring should include a precordial stethoscope, ECG, blood pressure, and rectal temperature. Anesthesia is maintained with fentanyl 0.02-0.03 mg/kg body wt. and pancuronium 0.08-0.1 mg/kg. One dose of atropine (0.02 mg/kg) is administered before fentanyl. Intraoperative ventilation is performed by hand or by use of a Siemens Servo ventilator. Thirty newborns were anesthetized for repair of a congenital diaphragmatic hernia with no intraoperative complication and an overall mortality of 27%.

Anesthesia↗

PubMed1989

[Treatment of transient ischemic attack by carotid endarterectomy].

Fourty-five patients with transient ischemic attack (TIA) were treated by carotid endarterectomy. All of them had typical manifestation of TIA and stenosis of extracranial carotid artery verified by angiography. After operation most of them were uneventful, but 2 experienced TIA, 2 contralateral reversible weakness and 1 mild hoarseness. There was no mortality. The role of carotid endarterectomy in the prevention and treatment of TIA, and some technical factors including anesthesia, intraoperative monitoring, management of stenosis of high subcranial internal carotid artery and postoperative care, were discussed.

Adult↗

PubMed1998

Three-dimensional transrectal ultrasound guided cryoablation for localized prostate cancer in nonsurgical candidates: a feasibility study and report of early results.

PURPOSE: A 3-dimensional (D) transrectal ultrasound imaging system was incorporated into the cryoablation routine for prostate cancer to assess its feasibility and use. The objective was to improve visibility for probe placement and for intraoperative monitoring. MATERIALS AND METHODS: A commercially available transrectal ultrasound unit was coupled with a custom designed software system to construct 3-dimensional prostate images. A total of 52 patients with clinically localized prostate cancer, in whom radiotherapy had failed (45) or who were otherwise judged to be nonsurgical candidates (7) were treated with cryoablation, using 3-D transrectal ultrasound for intraoperative guidance. RESULTS: In all cases the intraoperative 3-D transrectal ultrasound images provided a unique coronal view of the prostate, revealing useful information and facilitating more precise probe placement and treatment monitoring. Early postoperative histological and biochemical results and complication rates compare well with other contemporary series. CONCLUSIONS: Although the precise role of cryoablation in the management of prostate cancer remains unclear and long-term results are pending, incorporation of a 3-D transrectal ultrasound imaging system into the cryoablation routine proved to be feasible and appeared to be a worthwhile effort to facilitate the procedure, and deserves further evaluation.

Cryosurgery↗

PubMed2003

Anesthetic management of a patient with methemoglobinemia.

Methemoglobinemia results from the oxidation of the ferrous iron in hemoglobin to the ferric iron state. Methemoglobin is incapable of carrying O2, and high levels may impact on O2 delivery to the tissues. Methemoglobinemia may result from congenital deficiencies of enzymes that normally convert methemoglobin to hemoglobin, alterations in the hemoglobin molecule itself or, most commonly, from the ingestion of medications or toxins that oxidize the ferrous iron of hemoglobin. Several issues must be considered when anesthetizing patients with methemoglobinemia, including the potential for decreased O2 delivery, which may be exacerbated by intraoperative blood loss and anemia, interference with normal intraoperative monitoring devices, and the potential for medications to cause or exacerbate methemoglobinemia. We describe a patient with acquired methemoglobinemia from dapsone therapy who required anesthetic care for shoulder arthroscopy. The patient's drug-induced methemoglobinemia was diagnosed intraoperatively during previous anesthesia on the basis of discrepancy between the O2 saturation noted by pulse oximetry and that obtained from arterial blood gas analysis. Anesthetic care for patients with methemoglobinemia is discussed and a review of methemoglobinemia presented.

Anesthesia↗

PubMed1988

Electrocochleography: methods and clinical applications.

The use of electrocochleography (ECoG) as a tool in the diagnosis, assessment, and monitoring of certain neuro-otologic disorders has attracted renewed attention in the United States. The use of ECoG among otologists and audiologists has increased in recent years, primarily due to the availability of relatively easily applied, noninvasive extratympanic electrodes. Information derived from ECoG recordings has been shown to be helpful in the objective identification and monitoring of Meniere's disease and endolymphatic hydrops. In addition, ECoG may be used to enhance our ability to observe the most peripheral component of the auditory brain stem response (Wave I) for routine clinical assessment or during intraoperative monitoring procedures in which certain structures of the ear are at risk for permanent damage. This article provides an overview of current techniques and clinical applications of ECoG.

Audiometry, Evoked Response↗

PubMed1984

Monitoring with two-dimensional transesophageal echocardiography. Comparison of myocardial function in patients undergoing supraceliac, suprarenal-infraceliac, or infrarenal aortic occlusion.

When the aorta must be temporarily occluded at the suprarenal or supraceliac levels during surgery, the resulting large increase in afterload may make the myocardium ischemic, even though systemic and pulmonary artery pressures and cardiac output are maintained at normal levels. These traditional indices of myocardial well-being do not appear to be sufficiently sensitive, since cardiac complications are still the most frequent cause of perioperative death and morbidity after aortic reconstruction. To evaluate two-dimensional transesophageal echocardiography as a monitor of myocardial well-being, we studied 24 American Society of Anesthesiologists physical status class III or IV adult patients who were undergoing aortic reconstruction and occlusion at the supraceliac (n = 12), suprarenal-infraceliac (n = 6), or infrarenal (n = 6) level. In addition to traditional monitors, we used a gastroscope tipped with a special 3.5 MHz two-dimensional echocardiographic transducer (Diasonics) that was placed in the esophagus to give a cross-sectional view of the left ventricle through the base of the papillary muscles. The hemodynamic effects of clamping the aorta were managed by administration of vasodilating drugs, anesthetics, and fluids to keep systemic and pulmonary arterial pressures normal. Occlusion at the supraceliac level caused major increases in left ventricular end-systolic and end-diastolic areas, decreases in ejection fraction, and frequent wall motion abnormalities; these changes were not detected by conventional monitoring devices. Occlusion at the suprarenal-infraceliac level caused similar but smaller changes, and occlusion at the infrarenal level caused only minimal cardiovascular effects. We conclude that the two-dimensional transesophageal echocardiogram offers promise as an intraoperative monitoring device.

Aged↗

PubMed1985

[Use of computer technology in training assistants in the anesthesia department].

The growing importance of computer technology in the fields of medical diagnosis and monitoring cannot be disputed. Few studies, however, have investigated the usefulness of computers in medical education. The following paper presents a teaching program for novice anaesthesists which helps demonstrate the problem of anaesthetizing high risk patients and conveys general guidelines for preoperative diagnosis and intraoperative monitoring. All data registered can be displayed on several video screens simultaneously. A printout of the guidelines is also available. Initial impressions of the program are presented.

Allied Health Personnel↗

PubMedDate not supplied

[Local anesthesia in hernia surgery].

After a short historical outline, the advantages of, the indication for, and the contraindications for local anaesthesia in hernial surgery are considered. The principal pharmacological characteristics of the most widely-employed local anaesthetics are set out. Preoperative preparation of the patient, intraoperative monitoring and the technique of local anaesthesia employed by the authors are described in detail.

Anesthesia, Local↗

PubMedDate not supplied

Perioperative management and monitoring of a super-obese patient.

Anesthetic management of super-obese patients is inferred from evidence which has been based on obese or morbidly obese patients. We present the perioperative management and monitoring of a 44-year-old 232-kg patient (BMI 70) admitted for laparoscopic gastric bypass surgery. Awake fiberoptic endotracheal intubation preceded induction with propofol and rocuronium. Anesthesia was maintained with desflurane and remifentanil. Desflurane was titrated on BIS values, whereas remifentanil was based on hemodynamic monitoring (invasive arterial pressure and HemoSonic). Rocuronium was administered based on ideal body weight and recovery of twitch tension. Safe and rapid extubation in the operating theatre was made possible by the use of short-acting agents coupled with continuous intraoperative monitoring. Recovery in the post-anesthesia care unit was uneventful, pain was managed with meperidine, and after 5 hours the patient was discharged to the surgical ward. Oxygen therapy and SpO2 monitoring were continued overnight. No desaturation episodes were recorded. Pain was managed with I.V. drip of ketorolac and tramadole.

Adult↗

PubMedDate not supplied

The use of somatosensory evoked responses in carotid surgery for monitoring brain function.

One of the problems in carotid surgery is the intra-operative detection of brain ischemia. None of the methods applied so far have been successful. Experience has shown that the results were unsatisfactory. Experimental studies have detected a strong correlation between regional cerebral blood flow and somatosensory evoked potentials. At the Surgical Clinic of the University of Cologne, 60 patients had continuous intraoperative monitoring of somatosensory evoked responses during carotid endarterectomy. Our previous experiences suggest that monitoring of somatosensory evoked responses during carotid endarterectomy provides a suitable method for the registration of brain function. Furthermore it is possible to pinpoint the causes of ischemia and to immediately begin treatment based on the causes of ischemia.

Aged↗

PubMed1998

The efficacy of left atrial to femoral artery bypass in the prevention of spinal cord ischemia during aortic surgery.

Surgical repair of traumatic lesions or aneurysmectomy of the descending thoracic aorta necessitates the interruption of distal aortic blood flow, a situation which invariably promotes proximal hypertension accompanied by a precipitous increase in cerebrospinal fluid pressure and distal hypoperfusion. All are significant determinants of postoperative paraplegia. The institution of aortic bypass, distal to cross-clamping, by either implantation of an extraluminal passive shunt or deployment of left atrial to femoral artery (LA-FA) cannulation with a centrifugal pump, is the most widespread modality to afford a means of proximal decompression and provide distal perfusion. Passive shunt techniques do not consistently provide optimal bypass efficiency, due to inherent limitations of device design and the inability to accurately monitor and control flow. The LA-FA bypass technique is superior to passive shunts in effecting proximal unloading by allowing for precise adjustment of blood flow to equilibrate proximal and distal aortic pressures. The concomitant use of cerebrospinal fluid drainage with LA-FA bypass can effectively reduce the incidence of postoperative paraplegia. Intraoperative monitoring of evoked potentials as a sensitive indicator of spinal cord ischemia should be considered an integral component of preserving cord function. The use of cerebrospinal fluid drainage and evoked potential monitoring in conjunction with LA-FA bypass is therefore highly advisable.

Aorta, Thoracic↗

PubMed1990

Effects of 2% lignocaine on somatosensory evoked potentials recorded in the extradural space.

We have studied the effects of extradural administration of 2% lignocaine at the L3-4 interspace on somatosensory evoked potentials recorded in the cervical extradural space before corrective surgery for idiopathic adolescent scoliosis. Eight patients in whom the equivalent volume of 0.9% sodium chloride solution was administered into the lumbar extradural space acted as a control group. Lignocaine 2% resulted in a decrease in overall amplitude, but its main effect was a significant decrease in the amplitude of the second and third peaks, suggesting an action on the dorsal columns of the spinal cord. A significant increase in latency was found in both the lignocaine and sodium chloride groups. We conclude that the use of extradural 2% lignocaine in patients undergoing scoliosis surgery may interfere with the intraoperative monitoring of somatosensory evoked potentials.

Adolescent↗

PubMed1985

Evaluation of sciatic nerve compromise during total hip arthroplasty.

Sciatic nerve function was monitored intraoperatively by somatosensory evoked potentials (SEP) in 50 patients during total hip arthroplasty. There were 12 instances of temporary nerve compromise in ten patients: three during acetabular preparation due to retraction, one due to reamer contact, six during femoral reaming due to positioning, and two during trial reduction due to inadequate shortening of the femoral neck. The technique for monitoring, causes, and incidence of nerve compromise during total hip arthroplasty are discussed. SEP monitoring may be especially useful in revision surgery.

Aged↗

PubMed2005

Assessing team performance in the operating room: development and use of a "black-box" recorder and other tools for the intraoperative environment.

BACKGROUND: The objective of this research was to develop a digital system to archive the complete operative environment along with the assessment tools for analysis of this data, allowing prospective studies of operative performance, intraoperative errors, team performance, and communication. Ability to study this environment will yield new insights, allowing design of systems to avoid preventable errors that contribute to perioperative complications. STUDY DESIGN: A multitrack, synchronized, digital audio-visual recording system (RATE tool) was developed to monitor intraoperative performance, including software to synchronize data and allow assignment of independent observational scores. Cases were scored for technical performance, participants' situational awareness (knowledge of critical information), and their comfort and satisfaction with the conduct of the procedure. RESULTS: Laparoscopic cholecystectomy (n = 10) was studied. Technical performance of the RATE tool was excellent. The RATE tool allowed real time, multitrack data collection of all aspects of the operative environment, while permitting digital recording of the objective assessment data in a time synchronized and annotated fashion during the procedure. The mean technical performance score was 73% +/- 28% of maximum (perfect) performance. Situational awareness varied widely among team members, with the attending surgeon typically the only team member having comprehensive knowledge of critical case information. CONCLUSIONS: The RATE tool allows prospective analysis of performance measures such as technical judgments, team performance, and communication patterns, offers the opportunity to conduct prospective intraoperative studies of human performance, and allows for postoperative discussion, review, and teaching. This study also suggests that gaps in situational awareness might be an underappreciated source of operative adverse events. Future uses of this system will aid teaching, failure or adverse event analysis, and intervention research.

Cholecystectomy, Laparoscopic↗

PubMed1989

Evoked-potential monitoring during dorsal root entry zone surgery. Patients with chronic pain.

Somatosensory evoked potentials (SEP) were monitored intraoperatively in 15 patients who underwent spinal cord radiofrequency thermal dorsal root entry zone (DREZ) lesion procedures to treat chronic deafferentation pain. We found a significant correlation between transient latency shifts (recovery to prelesion values in the postlesioning period) of the first positive peak of the SEP (P1) during lesion production and the patients' subsequent postoperative neurological status (p less than 0.01). Transient increases in P1 latency above 2 ms were associated with detectable but transient postoperative sensorimotor deficits that resolved weeks to months after surgery. In 1 patient, the intraoperative P1 latency failed to return to baseline values; this patient had irreversible postoperative sensorimotor dysfunction. In 9 patients, we confirmed the value of recording bilateral SEP, using the contralateral side of the spinal cord (with no lesions) as a control. This experience has resulted in an improved SEP monitoring strategy: we now reconsider the risk-benefit ratio of additional DREZ lesions if early lesion production results in increased P1 latency. Rapid normalization of the P1 latency indicates that any postoperative deficits likely will resolve. Failure of P1 latency to return to control levels during the surgical wound closure period (approximately 1 h) indicates the high probability of permanent neurological deficits.

Electrocoagulation↗

PubMed1997

Intraoperative parathyroid hormone monitoring during parathyroidectomy for secondary hyperparathyroidism.

BACKGROUND: The surgical management of secondary hyperparathyroidism by experienced surgeons is associated with excellent results. The presence of supernumerary glands and inadequate initial parathyroidectomy can lead to reoperations for recurrence. Intraoperative parathyroid hormone monitoring (qPTH), which has been described during parathyroidectomy for primary hyperparathyroidism, may be helpful in preventing or predicting the need for reoperation. This report describes the use of qPTH assays during parathyroidectomy in patients with secondary hyperparathyroidism. METHODS: Intraoperative parathyroid hormone (PTH) levels were determined in 13 patients with secondary hyperparathyroidism undergoing total parathyroidectomy with autotransplantation (n = 3) or subtotal parathyroidectomy (n = 10). Levels were determined using a modified immunochemiluminometric assay (qPTH). RESULTS: The average PTH levels before and after parathyroidectomy were 1599 pg/ml (620 to 2486 pg/ml) and 230.3 pg/ml (129 to 345 pg/ml), respectively. All patients had significant decreases in PTH levels after parathyroidectomy (mean, 84.6%). Symptoms were improved in all patients after operation. PTH levels at early follow-up were consistently below intraoperative levels. CONCLUSIONS: Intraoperative PTH monitoring reproducibly demonstrates the clinically relevant decrease in PTH levels after parathyroidectomy for secondary hyperparathyroidism similar to those previously documented in patients with primary hyperparathyroidism. Long-term follow-up and increasing numbers of patients are crucial in defining the role of qPTH monitoring during parathyroidectomy for secondary hyperparathyroidism.

Adult↗

PubMedDate not supplied

[Perioperative course of 17 cases of pheochromocytoma].

We analysed the perioperative course of 17 surgeries in 16 patients with pheochromocytoma between January 1981 and February 1995. The proportion of women was high (14/16 = 88%). All patients, except one, had hypertension (in three it was only sporadic). Twelve patients had complications or associated diseases. In 13 cases the pheochromocytoma was diagnosed before the operation: they were given preoperative pharmacological protection. The intraoperative monitoring included ECG, invasive blood pressure, CVP and when considered useful, a pulmonary catheter. During tumor handling, the increase in arterial pressure reached a higher level (p < 0.01) in the patients who did not receive preoperative adrenergic blockade versus those who did receive it (p < 0.05). Intraoperative nitroprussiate was needed in 13 cases (76%). Following tumour removal five patients required vasopressor support. One patient died two weeks after surgery due to septic shock. In the postoperative period eight patients had hypokalemia, a complication which has not been reported previously.

Adolescent↗

PubMed2004

Experimental study of the morphological and electromyographic characteristics of the most frequent iatrogenic lesions of the recurrent laryngeal nerves in thyroid surgery.

INTRODUCTION: Iatrogenic lesions of the recurrent laryngeal nerves remain one of the most severe and frequent complications in thyroid surgery. According to Eisele (Laryngoscope 1996;106:443) their incidence varies between 1% and 12% depending on the size of surgery. AIM: The aim of the study was to examine experimentally the type of neural lesion and the efficiency of stimulation electromyography for immediate evaluation of the recurrent laryngeal nerve function in the most common surgical traumas. MATERIAL AND METHODS: Ten clinically healthy and parasite-free male dogs of mixed breed weighing from 11 to 18 kg were used in the experiment. The injured laryngeal nerves of the experimental animals were examined histologically using Sudan III staining for myelin and Bilshovsky staining for neurofibrils. The intraoperative electromyography was performed with Neurostim 100. RESULTS: The results show severe damage both of the myelin sheath and neurofibrils in most of the surgical traumas of the nerve fiber. The electromyography of the laryngeal musculature shows complete interruption of the conduction of the action potential in all types of experimental lesions. CONCLUSION: EMG intraoperative monitoring of the laryngeal nerves appears the most effective measure to avoid the complication.

Animals↗