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Intraoperative monitorering

Kazuyoshi Kobayashi, Kei Ando, Ryuichi Shinjo, Kenyu Ito, Mikito Tsushima, Masayoshi Morozumi, Satoshi Tanaka, Masaaki Machino, Kyotaro Ota, Naoki Ishiguro, Shiro Imagama
STUDY DESIGN: Retrospective study. OBJECTIVE: The goal of the study was to investigate the significance of a change in latency in monitoring of transcranial muscle-action potential (Tc-MsEP) waveforms. SUMMARY OF BACKGROUND DATA: Tc-MsEP has become a common approach in spine surgery due to its sensitivity and importance in motor function. Many reports have defined the alarm point of Tc-MsEP waveform as a particular decrease in amplitude, but evaluation of the waveform latency has not attracted as much attention...
September 1, 2018: Spine
Navneh Samagh, Raghavendra K Pai, Thomas K Mathews, Kiran Jangra, Ravi G Varma
Background and Aims: Pre-emptive analgesia using caudal epidural technique is an underutilized technique in lumbosacral spine surgery patients. We intend to study if pre-emptive analgesia with a single caudal epidural injection of ropivacaine is an effective method of postoperative analgesia by assessing the quality and duration of pain relief and intraoperative opioid requirement. Material and Methods: Eighty patients undergoing lumbosacral spine surgeries by the posterior approach were randomized to ropivacaine (R) group ( n = 40) and saline (S) group ( n = 40)...
April 2018: Journal of Anaesthesiology, Clinical Pharmacology
Elisabeth Dewhirst, Hina Walia, Walter P Samora, Allan C Beebe, Jan E Klamar, Joseph D Tobias
Introduction: Cerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO2 ) using near-infrared spectroscopy (NIRS). Changes in rSO2 have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation. The aim of this study was to evaluate the changes in rSO2 during intraoperative changes in mechanical ventilation...
2018: Medical Devices: Evidence and Research
David L Penn, Kyle C Wu, Kayla R Presswood, Coleman P Riordan, R Michael Scott, Edward R Smith
Children with arteriovenous malformations (AVMs) are at cumulative, life-long risk of debilitating and fatal intracranial hemorrhage, especially with syndromes such as hereditary hemorrhagic telangiectasia. Cerebral angiography is the gold standard for diagnosis and allows simultaneous adjunctive embolization limiting radiation and contrast exposure and intraoperative blood loss, important in pediatric patients with low blood volume. Microsurgical resection of low-grade AVMs offers cure with minimal morbidity...
August 7, 2018: Operative Neurosurgery (Hagerstown, Md.)
Neil David Hauser, Justiaan Swanevelder
Trans-oesophageal echocardiography (TOE) has become an almost universal intraoperative monitor and diagnostic tool. The use of TOE in most cardiac, aortic, major vascular and transplant operations is used to aid anaesthetic management as well as assist surgical decision-making. In addition to the perioperative environment it is increasingly being used in the Outpatient Department, Emergency Department and Intensive Care settings. In this review we consider the safety associated with the use of TOE, we review the suggested contra-indications and areas that we would consider to TOE to be a necessity...
August 11, 2018: Echo Research and Practice
Jingwei Li, Shiwei Du, Liyong Sun, Feng Shang, Hongqi Zhang, Guilin Li
As a normal variation of the cerebral venous angioarchitecture, developmental venous anomalies (DVAs) represent a rare cause of intraparenchymal hemorrhage. Different from mixed vascular lesions, such as capillary malformations (CMs), arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), and thrombosis, here we describe the first case of a ruptured hemodynamic aneurysm associated with a DVA and introduce the first use of hybrid operation for the treatment of a hemorrhagic DVA. A 14-year-old girl suffered from sudden onset of headache, aphasia and left hemiplegia...
August 9, 2018: World Neurosurgery
Ian C Gibbs, Oluwole Fadahunsi, Natoya Reid, Andrea M Bonnick
Malignant hyperthermia is a rare condition that occurs in susceptible patients exposed to triggering anesthetic agents. It is associated with a high mortality rate if not recognized immediately and treated appropriately. A 52-year-old man presented to our clinic 2 days after an assault for management of jaw pain. A minimally displaced right parasymphyseal fracture and moderately displaced left body fracture of the mandible were diagnosed. There were no known drug allergies. The patient reported no previous difficulty with anesthesia, as well as no known prior adverse reactions to anesthesia in any relatives...
July 19, 2018: Journal of Oral and Maxillofacial Surgery
Fouzi Benboujja, Sarah Bowe, Caroline Boudoux, Christopher Hartnick
Importance: Recurrent respiratory papillomatosis (RRP) is a viral-induced disease caused by human papillomavirus and the second leading cause of dysphonia in children; however, neither a cure nor a definitive surgical treatment is currently available for RRP. Although laser therapy is often used in the treatment of RRP, the lack of real-time laser-tissue interaction feedback undermines the ability of physicians to provide treatments with low morbidity. Therefore, an intraoperative tool to monitor and control laser treatment depth is needed...
August 9, 2018: JAMA Otolaryngology—Head & Neck Surgery
Jong-Hyeok Park, Sun-Ho Lee, Eun-Sang Kim, Whan Eoh
OBJECTIVE: To evaluate the validity of intraoperative somatosensory-evoked potential (SSEP) and motor-evoked potential (MEP) monitoring according to two different warning criteria during 6 months from intramedullary spinal ependymoma (IMSE) surgery. METHODS: Twenty-six patients who underwent IMSE surgery with intraoperative monitoring from January 2010 to June 2017 were retrospectively analyzed. We examined the sensitivity, specificity, positive predictable value (PPV), negative predictable value (NPV), and diagnostic odds ratio (DOR) of SSEP and MEP monitoring for each extremity according to two warning criteria: 50% decline and all-or-none...
August 7, 2018: World Neurosurgery
Bin Wang, An-Ping Su, Teng-Fei Xing, Han Luo, Wan-Jun Zhao, Jing-Qiang Zhu
To evaluate the function of carbon nanoparticles during the thyroid reoperation for carcinoma, we conducted this study by retrospectively analyzing the data of patients who underwent at least completion thyroidectomy with bilateral central lymph nodes dissection for thyroid carcinoma from January 2009 to June 2016. The clinicopathologic characteristics and surgical details were compared between the patient who accepted intraoperative carbon nanoparticles injection and those who accepted nothing injection during the surgery...
August 2018: Medicine (Baltimore)
Sarah Palsen, Albert Wu, Sascha S Beutler, Robert Gimlich, H Keri Yang, Richard D Urman
There is a growing body of literature documenting the use of deep neuromuscular block (NMB) during surgery. Traditional definitions of depth of NMB rely on train-of-four assessment, which can be less reliable in retrospective studies. The goal of our study was to investigate the real-world practice pattern of dosing of neuromuscular blocking agents (NMBA), utilizing the amount of NMBA used during the course of a case, adjusted for patient weight and case duration, as a surrogate measure of depth of NMB. We also aimed to identify case factors associated with larger NMBA doses...
August 9, 2018: Journal of Clinical Monitoring and Computing
Ahmet Selim Ozkan, Muharrem Ucar, Sedat Akbas
OBJECTIVES: To investigate the relationships between secondhand smoke (SHS) exposure and oxygenation during one-lung ventilation (OLV) in lobectomy surgery and between SHS exposure and postoperative analgesic consumption. DESIGN: Prospective study. SETTING: University, Faculty of Medicine, operating room. PARTICIPANTS: Sixty adult patients with American Society of Anesthesiologists score II to III, aged 18 to 65 years, with a body mass index (BMI) <35 kg/m2 scheduled for lobectomy surgery by open thoracotomy...
July 2, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Rohesh J Fernando, Emily Williamson, Eduardo J Goenaga Díaz, Sean D Johnson
Intraoperative transesophageal echocardiography currently is used routinely for many cardiothoracic surgical procedures. Although it is often used for intraoperative cardiac monitoring and to confirm preoperative echocardiographic findings, it may sometimes result in the discovery of unexpected pathology. In this e-challenge, a patient was found to have a mitral valve abnormality that was not previously detected on the preoperative transthoracic echocardiogram. The mitral valve anomaly subsequently was evaluated to characterize the anatomy, interrogate the valve, and provide a diagnosis...
July 5, 2018: Journal of Cardiothoracic and Vascular Anesthesia
Jose L Sanmillan, Pablo Lopez-Ojeda, Isabel Fernández-Conejero, Alejandro Fernández-Coello, Gerard Plans, Yara Ali-Ciurana, Andreu Gabarrós
BACKGROUND: Eloquent area surgery has become safer with the development of intraoperative neurophysiological monitoring and brain mapping techniques. However, the usefulness of intraoperative electric brain stimulation techniques applied to the management and surgical treatment of cavernous malformations in supratentorial eloquent areas is still not proven. With this study, we aim to describe our experience with the use of a tailored functional approach to treat cavernous malformations in supratentorial eloquent areas...
August 8, 2018: Acta Neurochirurgica
Aabid Hassan Naik, Munir Ahmad Wani, Khursheed Alam Wani, Bashir Ahmad Laway, Ajaz Ahmad Malik, Zafar Amin Shah
Background: Parathyroidectomy has been traditionally performed through bilateral neck exploration (BNE). However, with the use of intraoperative parathyroid hormone (IOPTH) assay along with preoperative localization studies, focused parathyroidectomy can be performed with good surgical success rate, multiglandular disease can be predicted, and hence recurrence and surgical failure can be prevented. Furthermore, it predicts eucalcemia in the postoperative period. The aim of this study was to evaluate the usefulness of IOPTH assay in guiding adequate parathyroidectomy in patients of primary hyperparathyroidism...
May 2018: Indian Journal of Endocrinology and Metabolism
Aliasgar Moiyadi, Parthiban Velayutham, Jeson Doctor, Ashwin Borkar, Vikas Singh
Extent of resection is a very important prognostic marker in adult and pediatric brain tumors. Therefore, radical resections confer an oncological benefit. Resection of intra-axial tumors in proximity to eloquent regions requires intraoperative mapping and monitoring. Continuous subcortical mapping using a suction monopolar device has been recently described for adult tumors. This allows a real-time dynamic mapping of the advancing resection cavity walls, synchronized with the surgeon's actions during resection...
April 2018: Journal of Pediatric Neurosciences
Royce W Woodroffe, Mario Zanaty, Patricia Kirby, Brian J Dlouhy, Arnold H Menezes
This video is a case presentation and demonstration of surgical approach to a pediatric intramedullary spinal cord tumor (IMSCT). IMSCT can be associated with significant morbidity and aggressive resection is associated with more favorable long-term outcome. A 13-yr-old male presented to clinic for evaluation of rapidly progressive scoliosis to the left. A contrasted MRI revealed expansion of the spinal cord with edema from approximately T3 to T9 and an enhancing lesion at T6-7 associated with a small cyst...
July 31, 2018: Operative Neurosurgery (Hagerstown, Md.)
Jennifer Maw, Paul W Gidley
Intraoperative facial nerve monitoring (IOFNM) has evolved from requiring sophisticated electromyography equipment to a self-contained monitor with an auditory signal. Subspecialty ear surgeons currently use IOFNM in most otologic and temporal bone procedures as it improves facial nerve outcomes. Our competency and near-universal adoption of IOFNM notwithstanding, otolaryngologists are rarely reimbursed for this procedure. Subspecialists value this technology as medically necessary and should importune fair reimbursement for their expertise in this procedure that is so vital to patient safety...
August 7, 2018: Otolaryngology—Head and Neck Surgery
Krzysztof Majchrzak, Barbara Bobek-Billewicz, Anna Hebda, Piotr Adamczyk, Henryk Majchrzak, Piotr Ładziński
The aim of investigation was to assess treatment outcomes in adult patients with thalamic tumors, operated on with the aid of tractography (DTI) and monitoring of motor evoked potentials (MEPs) generated due to transcranial electrical stimulation (TES) and direct electrical stimulation (DES) of the subcortical white matter. 38 subsequent patients with thalamic tumors were operated on using tractography (DTI)-integrated neuronavigation, transcranial electrical stimulation (TES) and direct electrical stimulation (DES)...
July 17, 2018: Neurologia i Neurochirurgia Polska
David P Martin, Walter P Samora, Allan C Beebe, Jan Klamar, Laura Gill, Tarun Bhalla, Giorgio Veneziano, Arlyne Thung, Dmitry Tumin, N'Diris Barry, Julie Rice, Joseph D Tobias
PURPOSE: To provide optimal conditions for neurophysiological monitoring and rapid awakening, remifentanil is commonly used during pediatric spinal surgery. However, remifentanil may induce hyperalgesia and increase postoperative opioid requirements. We evaluated the potential of methadone or magnesium to prevent remifentanil-induced hyperalgesia. METHODS: Using a prospective, randomized, blinded design, adolescents presenting for posterior spinal fusion to treat idiopathic scoliosis were assigned to receive desflurane with remifentanil alone (REMI), remifentanil + methadone (MET) (0...
August 4, 2018: Journal of Anesthesia
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