Journal of clinical monitoring and computing
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J Clin Monit Comput · Jun 2024
Utility of desflurane as an anesthetic in motor-evoked potentials in spine surgery and the facilitating effect in tetanic stimulation of bilateral median nerves.
Although desflurane is a safe and controllable inhalation anesthetic used in spinal surgery, to our knowledge, there have been no reports of successful motor-evoked potential (MEP) recordings under general anesthesia with desflurane alone. A high desflurane concentration may reduce the risk of intraoperative awareness but can also reduce the success of MEP recording. Therefore, we aimed to evaluate the reliability of MEP monitoring and investigate whether tetanic stimulation can augment MEP amplitude under general anesthesia with high-concentration desflurane during spinal surgery. ⋯ The p-MEPm amplitudes were significantly higher than the c-MEP amplitudes in all muscles (P < 0.05), whereas the p-MEPt amplitudes were not significantly different from the c-MEP amplitudes. The MEP recording success rates for the gastrocnemius and quadriceps were inadequate. However, bilateral median nerve tetanic stimulation can effectively augment MEPs safely under general anesthesia with high-concentration desflurane in patients who undergo spinal surgery.
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J Clin Monit Comput · Jun 2024
Observational StudyUse of near infrared spectroscopy for the prediction of perioperative complications in patients undergoing elective microsurgical resection of cerebral arteriovenous malformations- a prospective observational trial (NIRSCAM trial).
Cerebral arteriovenous malformations (AVM) represent focal abnormal areas of low resistance circulation which render the peri-nidal neuronal tissue susceptible to ischemia. The post-excision cerebral perfusion surge can result in hyperaemic complications.We hypothesised that Near Infrared Spectroscopy (NIRS)-guided perioperative management can aid in the prediction and prevention of perioperative complications in patients presenting for surgical excision of cerebral AVMs. We also intended to identify a threshold value of regional cerebral oxygen saturation (rScO2) to predict the incidence of perioperative complications. ⋯ In patients undergoing cerebral AVM resection, a post-resection ipsilateral rScO2 increase by > 12% with a drift ratio of > 1.3 could signify cerebral hyperemia. A postoperative ipsilateral rScO2 drift > 14.5% with a drift ratio of 2.1 from the baseline is associated with postoperative complications in our study. Further multi-centric randomized control trials are needed to support our research findings.
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J Clin Monit Comput · Jun 2024
Comparative StudyCerebral oxygenation saturation in childhood: difference by age and comparison of two cerebral oximetry algorithms.
Few reports are available on the monitoring of regional cerebral oxygen saturation (rSO2) in pediatric patients undergoing non-cardiac surgical procedures. In addition, no study has examined the rSO2 levels in children of a broad age range. In this study, we aimed to assess and compare rSO2 levels in pediatric patients of different age groups undergoing non-cardiac surgery. ⋯ The values in INVOS 5100C and tNIRS-1 were affected by blood pressure and the minimum alveolar concentration of sevoflurane, respectively. In pediatric patients undergoing non-cardiac surgery, rSO2 values differed across the three age groups, and the pattern of these differences varied between the two oximeters employing different algorithms. Further research must be conducted to clarify cerebral oxygenation in children.