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Intraoperative monitorering

Orhan Bican, Charles Cho, Areli Suarez-Roman, Viet Nguyen, Leslie Lee, Scheherazade Le, Jeremy Heit, Robert Dodd, Jaime López
Pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) both mitigate and predict risks associated with endovascular embolization procedures. We present a series of patients undergoing endovascular intracranial embolization predominantly for AVMs both under general anesthesia and awake with the use of IONM. We reviewed our database to identify all patients undergoing endovascular procedures between January 1, 2014 and January 1, 2016. Awake patients were tested with SSEP, EEG and real time neurologic examination while TcMEPs were performed in all anesthetized patients...
February 13, 2019: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Seshadri Raju, Alexander Knight, William Buck, Corbin May, Arjun Jayaraj
BACKGROUND: Wallstents (Boston Scientific, Marlborough, Mass) are most commonly used in iliac-caval stenting. Approximately 20% of stented limbs require reintervention to correct in-stent restenosis (ISR) or stent compression (SC). Corrective balloon dilation to rated stent caliber (isodilation) is not always successful. We investigated whether modest overdilation of the Wallstent by 2 to 4 mm (10%-20%) beyond the rated diameter would yield better mechanical clearance of ISR/SC, leading to a larger flow channel, improved conductance, reduction of peripheral venous pressure, and better clinical outcome...
March 2019: Journal of Vascular Surgery. Venous and Lymphatic Disorders
Thomas Guiho, Christine Azevedo-Coste, David Guiraud, Claire Delleci, Grégoire Capon, Natalia Delgado-Piccoli, Luc Bauchet, Jean-Rodolphe Vignes
OBJECTIVESpinal cord injuries (SCIs) result in loss of movement and sensory feedback, but also organ dysfunction. Nearly all patients with complete SCI lose bladder control and are prone to kidney failure if intermittent catheterization is not performed. Electrical stimulation of sacral spinal roots was initially considered to be a promising approach for restoring continence and micturition control, but many patients are discouraged by the need for surgical deafferentation as it could lead to a loss of sensory functions and reflexes...
February 15, 2019: Journal of Neurosurgery. Spine
Ryo Kato, Kiyokazu Nakajima, Tsuyoshi Takahashi, Koji Tanaka, Yasuhiro Miyazaki, Tomoki Makino, Yukinori Kurokawa, Makoto Yamasaki, Masaki Mori, Yuichiro Doki
BACKGROUND: The fourth edition of New Japanese classification system for esophageal achalasia was revised after a long interval of 30 years in 2012. In this new system, achalasia is morphologically classified into 3 types, based on its X-ray findings. However, the system has been limitedly used in Japan and has not been fully validated in terms of its predictive capability of postoperative outcomes. The purpose of this study was to clarify the validity of new Japanese classification system for esophageal achalasia, as an index of patient characteristics and as a predictor of operative and mid/long-term postoperative outcomes...
February 15, 2019: Esophagus: Official Journal of the Japan Esophageal Society
Bruce R Kava, Diana M Lopatagui, Amanda Levine, Ranjith Ramasamy
INTRODUCTION: With the increasing utilization of ectopic reservoir placement during multicomponent penile implant surgery, safety concerns have been raised about whether passing the reservoir through the floor of the inguinal canal consistently results in placement of the reservoir within the correct location. AIM: To evaluate the safety, efficacy, and patient satisfaction associated with direct-vision, trans-fascial sub muscular reservoir placement in consecutive patients who had previously undergone radical cystectomy...
February 2019: Journal of Sexual Medicine
Robert A Tessler, Steve Vanhoy, Katherine Bergus, Christine Fong, Eileen M Bulger, Frederick P Rivara, Monica S Vavilala
BACKGROUND: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score may distinguish necrotizing soft tissue infection (NSTI) from non-NSTI. The association of higher preoperative LRINEC scores with escalations of intraoperative anesthesia care in NSTI is unknown and may be useful in communicating illness severity during patient handoffs. MATERIALS AND METHODS: We conducted a retrospective cohort study of first operative debridement for suspected NSTI in a single referral center from 2013 to 2016...
February 12, 2019: Journal of Surgical Research
Andrius Rybakovas, Augustinas Bausys, Andrius Matulevicius, Gytis Zaldokas, Mindaugas Kvietkauskas, Gintautas Tamulevicius, Virgilijus Beisa, Kestutis Strupas
Introduction: Recurrent laryngeal nerve injury is one of the major complications related to thyroid surgery. Intraoperative recurrent laryngeal nerve functional status monitoring is becoming a standard part of thyroid surgery. However, the current methods for intraoperative nerve functional status assessment are associated with a demand for specialized devices and increased costs. Aim: To assess the validity of a new method - intraoperative laryngeal ultrasonography - for prediction of recurrent laryngeal nerve injury...
January 2019: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Ken Matsushima, Michihiro Kohno, Nobuyuki Nakajima, Hitoshi Izawa, Norio Ichimasu, Yujiro Tanaka, Shigeo Sora
OBJECTIVE: The intraforaminal component of jugular foramen tumors is difficult to access surgically, as it requires complex approaches for radical removal and leads to a high recurrence due to residual tumor. The retrosigmoid suprajugular approach, intradural drilling of the roof of the jugular foramen, has been recently proposed for removal of such intraforaminal component without sacrificing the sigmoid-jugular venous system or requiring additional approaches. This study presents our experience with this approach and introduces the utility of intraoperative continuous vagus nerve monitoring...
February 11, 2019: World Neurosurgery
Fang Zhu, Jason Chui, Ian Herrick, Janet Martin
OBJECTIVES: We aim to evaluate the diagnostic test accuracy (DTA) of intraoperative evoked potential (EP) monitoring to detect cerebral injury during clipping of cerebral aneurysms. DESIGN: Systematic review. DATA SOURCES: Major electronic databases including MEDLINE, EMBASE, LILACS. ELIGIBILITY CRITERIA: We included studies that reported the DTA of intraoperative EP monitoring during intracranial aneurysm clipping procedures in adult patients...
February 12, 2019: BMJ Open
Satoshi Yoshida, Ryoji Takazawa, Yusuke Uchida, Yusuke Kohno, Yuma Waseda, Toshihiko Tsujii
We examined the renal pelvic urine culture (RPUC) and stone culture (SC) during ureteroscopy and evaluated their associations with postoperative systemic inflammatory response syndrome (SIRS). We prospectively collected data of 224 patients who underwent ureteroscopic laser lithotripsy from March 2015 to December 2017. We examined the bladder urine culture pre-operatively. If the patients had positive culture results, we treated them with antibiotics for 5-7 days before surgery based on the sensitivity profile...
February 13, 2019: Urolithiasis
Shangyi Hui, Liyuan Tao, Feroze Mahmood, Derong Xu, Zhinan Ren, Xin Chen, Lin Sheng, Qianyu Zhuang, Shugang Li, Yuguang Huang
BACKGROUND: Tranexamic acid (TXA) has been routinely delivered in multisegmental spinal decompression and bone graft fusion surgeries with satisfactory outcomes in minimizing gross blood loss and transfusion demands. However, concerns remain that intravenously delivered TXA (ivTXA) may increase risks of postoperative convulsive seizures and systemic thrombogenicity. Topical use of TXA (tTXA), being more targeted to the surgical bleeding site while minimizing patient systemic exposure to ivTXA, has been successfully applied to attenuate blood losses and transfusion requirements in hip and knee arthroplasty...
February 12, 2019: Trials
Zhigang Chen, Jason M Ali, Huan Xu, Lei Jiang, Giuseppe Aresu
Subxiphoid video-assisted thoracoscopic surgery (VATS) is a surgical approach in minimally invasive thoracic surgery that aims to aid enhanced recovery by reducing postoperative pain by avoiding instrumentation of the intercostal spaces. Access through a subxiphoid port presents challenges for both the surgeon and anaesthetist. Particularly for left sided procedures, the heart can be compressed resulting in arrhythmia and haemodynamic compromise. The anaesthetic team play an important role in ensuring the success of subxiphoid VATS procedures...
December 2018: Journal of Thoracic Disease
Sungho Lim, Michael J Javorski, Sean P Nassoiy, Yaeji Park, Pegge M Halandras, Carlos F Bechara, Bernadette Aulivola, Paul R Crisostomo
OBJECTIVE: The baroreceptor at the carotid body plays an important role in hemodynamic autoregulation. Manipulation of the baroreceptor during carotid endarterectomy (CEA) or radial force from carotid artery angioplasty and/or stenting (CAS) may cause both intraoperative and postoperative hemodynamic instability. The purpose of this study is to evaluate the long-term effects of CEA and CAS on blood pressure (BP), heart rate (HR), and subsequent changes on antihypertensive medications...
February 11, 2019: Vascular and Endovascular Surgery
Alice M Kai, Nalini Vadivelu, Feng Dai, Susan Dabu-Bondoc, Hosni Mikhael, Peter A Blume
BACKGROUND: Studies on obtaining donor skin graft using intravenous sedation for patients undergoing major foot surgeries in the same operating room visit have not previously been reported. The objective of this retrospective study is to demonstrate that intravenous sedation in this setting is both adequate and safe in patients undergoing skin graft reconstruction of the lower extremities in which donor skin graft is harvested from the same patient in one operating room visit. METHODS: Medical records of 79 patients who underwent skin graft reconstruction of the lower extremities by one surgeon at the Yale New Haven Health System between November 1, 2008, and July 31, 2014, were reviewed...
November 2018: Journal of the American Podiatric Medical Association
Enrique Sanchis, Silvia Casans, Giuseppe Felici, Rafael García-Gil, Enrique Sanchis-Sánchez, Ignacio Pérez-Calatayud, Maria José Pérez-Calatayud, José Pérez-Calatayud
PURPOSE: The aim of this work is to develop a bleeding detector integrated into the acrylic circular applicators for specific mobile linacs. Thus, a bleeding detector has been developed based on a capacitive sensor to be used with plastic applicators, as in the case of LIAC HWL from Sordina IORT Technologies SpA. According to the clinical impact, we have selected 0.5 cm as the minimum depth of fluid that should be detected. METHODS: An experiment was developed using water-simulating blood...
January 2019: Physica Medica: PM
Estefanía Gómez-Pesquera, Rodrigo Poves-Alvarez, Beatriz Martinez-Rafael, Pilar Liu, Javier Alvarez, Mario Lorenzo-López, Inmaculada Fierro, Esther Gómez-Sánchez, María Heredia-Rodriguez, José Ignacio Gómez-Herreras, Eduardo Tamayo
OBJECTIVE: To evaluate if an intraoperative cerebral regional oxygen saturation (crSO2 ) decrease, less pronounced than 20% below baseline (the current threshold believed to be associated with cognitive dysfunction in adults), is associated with negative postoperative behavioral changes (NPOBC) in the pediatric population after noncardiac surgeries. STUDY DESIGN: A prospective observational study was conducted with 198 children aged 2-12 years old scheduled for noncardiac procedures under general anesthesia...
February 5, 2019: Journal of Pediatrics
Yang Jiao, Bin He, Xingyu Tong, Ran Xia, Chengmi Zhang, Xueyin Shi
INTRODUCTION: Under-dosage or over-dosage of intraoperative analgesia can cause harm to patients. Many studies have demonstrated the clinical advantages of nociception monitoring tools, but with some conflicting results. To clarify the issue, this meta-analysis compared the effects of analgesia nociception index (ANI), surgical pleth index (SPI), and pupillometry monitoring methods with those of analgesia management practices of intraoperative opioid administration. EVIDENCE ACQUISITION: A comprehensive literature search was conducted to identify clinical trials that compared the effect of monitoring of nociception- antinociception balance (versus clinical signs) on intraoperative opioid administration...
February 7, 2019: Minerva Anestesiologica
Maitane I Orue-Echebarria, Javier Vaquero, Cristina J Lisbona, Pablo Lozano, Miguel A Steiner, Álvaro Morales, José Á López-Baena, Juan Laso, Inmaculada Hernández, Luis Olmedilla, José L García Sabrido, Isabel Peligros, Emma Sola, Carlos Carballal, Elena Vara, J M Asencio
INTRODUCTION: The term "Small-for-Flow" reflects the pathogenetic relevance of hepatic hemodynamics for the "Small-For-Size" syndrome and posthepatectomy liver failure. We aimed to characterize a large-animal model for studying the "Small-for-Flow" syndrome. METHODS: We performed subtotal (90%) hepatectomies in 10 female MiniPigs using a simplified transection technique with a tourniquet. Blood tests, hepatic and systemic hemodynamics, and hepatic function and histology were assessed before (Bas), 15 min (t-15 min) and 24 h (t-24 h) after the operation...
February 7, 2019: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Ahmed R Rizk, Marcus Mehlitz, Martin Bettag
Background and Study Aim  Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases. Methods and Results  We are presenting two cases of VS with significant facial weakness. The first case was a 63-year-old male patient presented with 3 weeks' history of severe left-sided facial weakness (House-Brackmann [HB] grade V) and hearing loss. Magnetic resonance imaging (MRI) of the brain showed a tumor in the left internal auditory canal...
February 2019: Journal of Neurological Surgery. Part B, Skull Base
Mohit N Gilotra, Ashley Klein, Nabil Elkassabany, Andrew F Kuntz, G Russell Huffman, David L Glaser
PURPOSE: The goals of this study were 2-fold: (1) to determine the risk factors for cerebral desaturation events (CDEs) after implementation of a comprehensive surgical and anesthetic protocol consisting of patient risk stratification, maintenance of normotensive anesthesia, and patient positioning in a staged fashion, and (2) to assess for subclinical neurologic decline associated with intraoperative ischemic events through cognitive testing. METHODS: One hundred patients undergoing shoulder surgery in the beach chair position were stratified for risk of CDE based on Framingham stroke criteria, body mass index (BMI), and history of cerebrovascular accidents...
February 4, 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
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