Journal of clinical monitoring and computing
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J Clin Monit Comput · Oct 2021
Correlation between preoperative somatosensory evoked potentials and intraoperative neurophysiological monitoring in spinal cord tumors.
Intraoperative neurophysiological monitoring (IONM) is widely used in spinal cord tumors (SCTs) removal surgery. This study mainly hypothesized that patients with prolonged latency of preoperative somatosensory evoked potentials (preSEPLat) would have more deteriorated intraoperative evoked potentials. Among 506 patients who underwent SCTs removal surgery, 74 underwent both preSEPs and IONM. ⋯ PreSEPs are helpful in predicting the significant changes in ioSEPs during IDEM tumor removal surgery. The tumor-occupying area ratio and anatomical type are contributing factors for the transient PMD, whereas ioSEPs are prognostic factors in predicting the PMD that persists over 4 weeks after SCTs removal surgery. To our knowledge, this is the first study that mainly focused on the correlations of preoperative and intraoperative evoked potentials.
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J Clin Monit Comput · Oct 2021
Automatic detection of venous air embolism using transesophageal echocardiography in patients undergoing neurological surgery in the semi-sitting position: a pilot study.
Neurological surgery in the semi-sitting position is linked with a pronounced incidence of venous air embolism (VAE) which can be fatal and therefore requires continuous monitoring. Transesophageal echocardiography (TEE) provides a high sensitivity for the intraoperative detection of VAE; however, continuous monitoring with TEE requires constant vigilance by the anaesthesiologist, which cannot be ensured during the entire surgical procedure. We implemented a fully automatic VAE detection system for TEE based on a statistical model of the TEE images. ⋯ Our proposed algorithm might possibly even offer a higher sensitivity compared to manual detection. The specificity, however, requires improvement to be acceptable for practical application. Trial Registration: German Clinical Trials Register (DRKS00011607).
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J Clin Monit Comput · Oct 2021
Oxygen desaturation and time burden during tracheobronchial endoscopy for suspected foreign body in toddlers.
Tracheobronchial endoscopy with general anaesthesia for suspected foreign body aspiration exposes toddlers to acute hypoxemia. Better quantification of intraoperative hypoxemia could help identify and manage the most severe patients. We explored the hypoxic burden approach to account for both duration and depth of desaturation episodes during the procedure and determined risk factors for high hypoxic burden. ⋯ High hypoxic burden was associated with an increased risk of postoperative invasive ventilation (OR 32, 95% CI 1.7-617) and of hospital stay > 24 h (OR 4.0, 95% CI 1.6-10). No postoperative neurological sequelae were found. The hypoxic burden approach, when applied in tracheobronchial endoscopy for suspected foreign body aspiration in toddlers, enabled the quantification of hypoxemia and the search for specific risk factors.
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J Clin Monit Comput · Oct 2021
Observational StudyForeseeing postoperative pain in neurosurgical patients: pupillometry predicts postoperative pain ratings-an observational study.
Pupillary reflex dilation (PRD) is triggered by noxious stimuli and diminished by opioid administration. In the postoperative period, PRD has been shown to be correlated with pain reporting and a useful tool to guide opioid administration. In this study we assessed whether pupillary measurements taken before extubation were related with the patient's reported pain in the Post-Anesthesia Care Unit (PACU) using the Numerical Rating Scale (NRS). ⋯ We also found a negative correlation between pupil diameter and age (rS = - 0.42, P = 0.04). The statistically significant correlation between pre-extubation PPI scores and NRS scores, as well as between the pupillary diameter before tetanic stimulation and NRS scores suggest the possibility of titrating analgesia at the end of the intraoperative period based on individual responses. This could allow clinicians to identify the ideal remifentanil concentration for the postoperative period.
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J Clin Monit Comput · Oct 2021
Observational StudyA modified train-of-four ratio to assess recovery from depolarizing neuromuscular blockade after succinylcholine, a prospective observational study.
Succinylcholine is still used in clinical practice. Its duration is highly variable and neuromuscular monitoring is recommended to assess its recovery. Unfortunately, depolarizing neuromuscular block cannot be evaluated by train-of-four (TOF) as no fade occurs. ⋯ It was10.0 [8.0-13.0] min vs 10.0 [8.0-12.0] min, P = 0.307 and 10.0 [9.0-15.0] min vs 10.0 [8.0-15.0] min, P = 0.546; respectively; median [IQR]. Agreement between both parameters was excellent. The T4/Tref can be used accurately to measure recovery from depolarizing neuromuscular block.