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Cardiovascular neuromonitoring

Rudolf Mörgeli, Kathrin Scholtz, Johannes Kurth, Sascha Treskatsch, Bruno Neuner, Susanne Koch, Lutz Kaufner, Claudia Spies
INTRODUCTION: Elderly patients suffering from gastrointestinal malignancies are particularly prone to perioperative complications. Elderly patients often present with reduced physiological reserves, and comorbidities can limit treatment options and promote complications. Surgeons and anesthesiologists must be aware of strategies required to deal with this vulnerable subgroup. METHODS: We provide a brief review of current and emerging perioperative strategies for the treatment of elderly patients with gastrointestinal malignancies and frequent comorbidities...
August 2017: Visceral Medicine
Han-Kun Chen, Chun-Liang Chen, Kuo-Shan Wen, Yi-Feng Lin, Kai-Yuan Lin, Yih-Huei Uen
BACKGROUND: The novel concept of continuous intraoperative neuromonitoring (Cont-IONM) through stimulation of the vagal nerve has been used in thyroidectomies to prevent imminent injury of the recurrent laryngeal nerve (RLN). This article reports on this technology and the results of using transoral Cont-IONM in natural orifice transluminal endoscopic surgery for thyroid disease. METHODS: Cont-IONM of the RLN was achieved through automatic cyclical stimulation of the vagal nerve using a C2 monitor and delta stimulating electrode...
January 2018: Surgical Endoscopy
Jerry Ingrande, Hendrikus Jm Lemmens
Anesthesiologists are unique among most physicians in that they routinely use technology and medical devices to carry out their daily activities. Recently, there have been significant advances in medical technology. These advances have increased the number and utility of medical devices available to the anesthesiologist. There is little doubt that these new tools have improved the practice of anesthesia. Monitoring has become more comprehensive and less invasive, airway management has become easier, and placement of central venous catheters and regional nerve blockade has become faster and safer...
2014: Medical Devices: Evidence and Research
Nathaniel H Greene, Mohammed M Minhaj, Ahmed F Zaky, Irene Rozet
OBJECTIVE: To examine current trends in anesthetic practice for management of carotid endarterectomy (CEA) and how practice may differ by groups of practitioners. DESIGN: An online survey was sent to the Society of Cardiovascular Anesthesiologists and Society of Neuroscience, Anesthesiology, and Critical Care e-mail list servers. Responses were voluntary. SETTING: Academic medical centers and community-based hospitals providing perioperative care for a CEA in the United States and abroad...
August 2014: Journal of Cardiothoracic and Vascular Anesthesia
Kristin Engelhard
PURPOSE OF REVIEW: Different techniques and interventions that can be used by an anaesthesiologist to minimize the perioperative stroke risk are summarized. RECENT FINDINGS: The most important risk factors for perioperative stoke are not modifiable, for example previous stroke or renal failure, but they can be used to identify patients with a high risk for perioperative stroke. The antiplatelet therapy should be continued in patients with a high risk for cardiovascular thrombosis...
June 2013: Current Opinion in Anaesthesiology
Matthew A Koenig
PURPOSE OF REVIEW: The purpose of this article is to describe the modern management of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH). SAH causes an inflammatory reaction to blood products in the basal cisterns of the brain, which may produce cerebral ischemia and strokes through progressive narrowing of the cerebral artery lumen. This process, known as cerebral vasospasm, is the most common cause of DCI after SAH. Untreated DCI may result in strokes, which account for a significant portion of the death and long-term disability after SAH...
June 2012: Continuum: Lifelong Learning in Neurology
Raimund Helbok, Ronny Beer, Andreas Chemelli, Florian Sohm, Gregor Broessner, Peter Lackner, Martin Sojer, Bettina Pfausler, Claudius Thomé, Erich Schmutzhard
BACKGROUND: Aortic coarctation (AC) rarely remains undiagnosed until adulthood. Intracranial aneurysms and spontaneous subarachnoid hemorrhage (SAH) are more frequent in patients with AC than in the general population. METHODS: The purpose of this report is to describe the management of a poor grade SAH patient with previously undiagnosed AC using advanced monitoring techniques of the brain and the cardiovascular system. RESULTS: A 28-year-old man with previously unknown AC was admitted with aneurysmal SAH WFNS grade 5...
June 2011: Neurocritical Care
A Greiner, J Grommes, S Lancer, R Autschbach, M J Jacobs
Marfan Syndrome is a heritable disorder of connective tissue leading to aortic aneurysms and other cardiovascular complications associated with reduced life expectancy. Marfan patients with thoracic aortic aneurysms (TAAs) or with thoracoabdominal aortic aneurysms (TAAAs) should be treated by means of open surgery, requiring an extensive protocol, including extracorporeal circulation, neuromonitoring and adjunctive modalities to provide organ protection. Then, open surgical repair of TAA(A)s are associated with excellent results...
October 2010: Journal of Cardiovascular Surgery
J Mracek, I Holecková, J Mork, J Frdlík, J Skorpil
AIM OF STUDY: To demonstrate the benefit of peroperative electrophysiological monitoring and neuroprotection in cardiac surgery that makes use a cardiopulmonary bypass in patients with a high risk of stroke and to analyze the importance of prophylactic carotid endarterectomy. BACKGROUND: Cerebral ischemia is the most dreaded complication of cardiovascular operations that make use of a cardiopulmonary bypass. It is necessary to select an approach that minimalizes neurological complications...
May 2009: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
G Erdös, I Tzanova, U Schirmer, J Ender
OBJECTIVE: The primary objective of this nationwide survey carried out in department of cardiac anesthesia in Germany was to identify current practice with regard to neuromonitoring und neuroprotection. METHODOLOGY: The data are based on a questionnaire sent out to all departments of cardiac anesthesia in Germany between October 2007 und January 2008. The anonymized questionnaire contained 26 questions about the practice of preoperative evaluation of cerebral vessels, intra-operative use of neuromonitoring, the nature und application of cerebral protective measures, perfusion management during cardiopulmonary bypass, postoperative evaluation of neurological status, and training in the field of cerebral monitoring...
March 2009: Der Anaesthesist
Fabio Guarracino
PURPOSE OF REVIEW: Recent publications have reported on the neurologic complications in cardiovascular surgery. They are frequent, and have surpassed the mortality rate in cardiac surgery. Brain injury compromises surgical results and the patient's outcome. This review reports on the recent literature on neuromonitoring tools used to prevent and reduce brain injury in cardiovascular surgery. RECENT FINDINGS: In the past year a good correlation between cerebral oxymetry and flow velocity by transcranial Doppler ultrasonography during carotid endarterectomy has been demonstrated, but this technique did not detect reliable flow velocity in 35% of cases...
February 2008: Current Opinion in Anaesthesiology
Martin Smith
PURPOSE OF REVIEW: The aim of this article is to summarize recent concepts regarding the intensive care management of patients with subarachnoid haemorrhage, emphasizing the detection and treatment of cerebral vasospasm and the management of systemic complications. RECENT FINDINGS: Aneurysmal subarachnoid haemorrhage is a potentially devastating disease that requires complex treatment strategies and extended monitoring. The prognosis of subarachnoid haemorrhage depends on the severity of the initial bleed, the success of the procedure to secure the aneurysm and the occurrence and severity of sequelae, including cerebral vasospasm...
October 2007: Current Opinion in Anaesthesiology
Michael A Sloan
All neuromonitoring techniques, although imperfect, provide useful information for monitoring cardiothoracic and carotid vascular operations. They may be viewed as providing complementary information, which may help surgical technique and, as a result, possibly improve clinical outcomes. As of this writing, the efficacy of TCD and NIRS monitoring during cardiothoracic and vascular surgery cannot be considered established. Well designed, prospective, adequately powered, double-blind, and randomized outcome studies are needed to determine the optimal neurologic monitoring modality (or modalities), in specific surgical settings...
November 2006: Neurologic Clinics
Taeun Chang, Richard A Jonas
With significant advances in surgical technology and methodology, mortality from congenital heart surgery has been significantly reduced in recent decades. Therefore, focus has naturally turned towards predicting, evaluating, and preventing the neurodevelopmental morbidity associated with congenital heart disease and its treatment. This paper reviews recent publications evaluating preoperative neurologic abnormalities and injuries, current neurodevelopmental outcomes of congenital heart repair, and various neuromonitoring modalities that can be used to monitor neurologic function/dysfunction perioperatively...
March 2006: Current Neurology and Neuroscience Reports
John M Murkin
Neurologic damage after cardiac surgery remains an important cause of postoperative morbidity. In addition to a wide variety of procedural risks, patient-specific factors such as the presence of extracranial or intracranial atherosclerotic disease, either alone or together, have a fundamental impact on the risk of brain injury developing after cardiovascular surgery. A variety of neurophysiologic monitoring techniques have been used during cardiovascular surgery in hopes of averting neurologic injury. In this issue of Seminars, the strengths and weaknesses of each are discussed by a group of highly experienced clinical investigators...
June 2004: Seminars in Cardiothoracic and Vascular Anesthesia
J Sahuquillo, A Biestro, M P Mena, S Amorós, M Lung, M A Poca, M De Nadal, M Báguena, H Panzardo, J M Mira, A Garnacho, R D Lobato
The management of severe head injuries in general and that of high intracranial pressure (ICP) in particular are among the most challenging tasks in neurocritical care. One of the difficulties still faced by clinicians is that of reducing variability among centers when implementing management protocols. The purpose of this paper is to propose a standardized protocol for the management of high ICP after severe head injury, consistent with recently published clinical practice guidelines and other clinical evidence such as that provided by the systematic reviews of the Cochrane Collaboration...
April 2002: Neurocirugía
G Litscher, G Wenzel, G Niederwieser, G Schwarz
QiGong is an ancient and widely practiced Chinese meditation exercise. We studied the effects of QiGong on brain function with modern neuromonitoring tools in two subjects. In a male QiGong master (extremely trained practitioner), the technique induced reproducible changes in transcranial Doppler sonography, EEG, stimulus-induced 40 Hz oscillations, and near-infrared spectroscopy findings. Similar effects were seen after the application of multimodal stimuli and when the master concentrated on intense imagined stimuli (e...
July 2001: Neurological Research
H L Edmonds, R A Rodriguez, S M Audenaert, E H Austin, S B Pollock, B L Ganzel
This review describes the techniques currently used for quantitative neurophysiologic measurement during cardiac surgery and their potential impact on clinical outcome. Electroencephalography (EEG) characterizes cerebrocortical neuronal electrical activity and was part of some of the earliest cardiopulmonary bypass procedures, yet today it is not widespread use. Each of the common misunderstandings regarding a supposed limitation of this technology is explained. Its major genuine shortcoming, a lack of selectivity, may now be overcome with the combined use of additional monitoring modalities...
January 1996: Journal of Cardiothoracic and Vascular Anesthesia
F Lille, B Petit, S Margules, C Mazel, R Roy-Camille
Somatosensory evoked potentials (SEPs) were recorded in 165 patients from 185 operations for scoliosis and major spinal distortions, lumbar or cervical stenosis, post-traumatic malunions, or tumors. They were obtained by percutaneous stimulation of right and left median and tibial posterior nerves, and recorded on the scalp as recently, motor potentials (MPs) have also been obtained, by a trans-spinous stimulation rostral to the level of intervention. The protocol consists of pre- and post-operative recordings, as well as a continuous intra-operative monitoring...
May 1993: Neurophysiologie Clinique, Clinical Neurophysiology
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