1
|
Thuccani M, Joelsson S, Lilja L, Strålin A, Nilsson J, Redfors P, Rawshani A, Herlitz J, Lundgren P, Rylander C. The capacity of neurological pupil index to predict the absence of somatosensory evoked potentials after cardiac arrest - An observational study. Resusc Plus 2024; 17:100567. [PMID: 38328749 PMCID: PMC10848026 DOI: 10.1016/j.resplu.2024.100567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
Background In neurologic prognostication of comatose survivors from cardiac arrest, two independent predictors of poor outcome are the loss of the Pupillary light reflex (PLR) and the loss of the N20 response from Somatosensory Evoked potentials (SSEP). The PLR can be quantitatively assessed by pupillometry. Both tests depend on the midbrain, in which a dysfunction reflects a severe hypoxic injury. We reasoned that a certain level of defective PLR would be predictive of a bilaterally absent SSEP N20 response. Method Neurological Pupil index (NPi) from the pupillometry and the SSEP N20 response were registered >48 h after cardiac arrest in comatose survivors. Clinical data were retrospectively analyzed. A receiver operating characteristic curve was used to evaluate the capacity of NPi to predict bilaterally absent SSEP N20 response. An NPi threshold value resulting in <5% false positive rate (FPR) for bilaterally absent N20 response was identified. Results From February 2020 to August 2022, we included 54 patients out of which 49 had conclusive pupillometry and SSEP examinations. The NPi threshold value with FPR < 5% was 3.4, yielding 36% sensitivity (95% CI 18-55) and significantly discriminated between respective groups with preserved and bilaterally absent N20 response to SSEP (p-value <0.01). Conclusion In this limited cohort, NPi < 3.4 in patients remaining comatose >48 hours after cardiac arrest predicted bilateral loss of the SSEP N20 response with a FPR < 5%. If validated in a larger cohort, an NPi threshold may be clinically applied in settings where SSEP is unavailable.
Collapse
Affiliation(s)
- Meena Thuccani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Joelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linus Lilja
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesia and Intensive Care, Karlstad Central Hospital, Karlstad, Sweden
| | - Axel Strålin
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefin Nilsson
- Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Prehospen – Centre for Prehospital Research, University of Borås, Sweden
| | - Peter Lundgren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Prehospen – Centre for Prehospital Research, University of Borås, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Rylander
- Anaesthesiology and Intensive Care, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
2
|
Wang L, Du Y, Huang N, Yin N, Du J, Yang J, Jiang L, Mao Y. Clinical characteristics and anaesthetic management of severe scoliosis patients with spinal muscular atrophy: case series. Ann Med Surg (Lond) 2024; 86:643-649. [PMID: 38333301 PMCID: PMC10849356 DOI: 10.1097/ms9.0000000000001562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/18/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance There is no expert consensus or guidance on perioperative anaesthesia management for spinal surgery of spinal muscular atrophy (SMA) patients with severe scoliosis (Cobb≧90°). We provide a comprehensive summary of the perioperative characteristics observed in patients with SMA and propose an optimized perioperative management strategy for anaesthesia. Methods This study is a retrospective single-centre research. Twenty-six SMA patients with severe scoliosis underwent posterior spinal fusion surgery from September 2019 to September 2022 were enroled. The main outcomes were to show the patients' characteristics in anaesthesia, intra- and post-operative periods. Outcomes Nineteen patients underwent awake transnasal/transairway intubation. The median anaesthesia time of 25 patients treated under total intravenous anaesthesia was 425 min. After operation, the Cobb angle and correction rate in the coronal plane were median 54.0° and 54.4%. The length of mechanical ventilation with endotracheal intubation in ICU was median 17.5 h in 8 patients. The ICU length of stay of postoperative hospital was median 19 days. Postoperative pneumonia developed in nine patients, atelectasis in two patients, and pleural effusion in six patients. All patients did not need special oxygen therapy after discharge. Conclusion Multidisciplinary consultation, lung-protective ventilation strategy, appropriate anaesthetic drugs and reasonable blood transfusion scheme and postoperative monitoring were important in anaesthesia, intraoperative and postoperative periods in the patients of severe scoliosis with spinal muscular atrophy.
Collapse
Affiliation(s)
- Lai Wang
- Department of Anesthesiology and Surgical Intensive Care Unit
| | - Yi Du
- Department of Anesthesiology and Surgical Intensive Care Unit
| | - Na Huang
- Department of Anesthesiology and Surgical Intensive Care Unit
| | - Na Yin
- Department of Anesthesiology and Surgical Intensive Care Unit
| | - Junming Du
- Department of Anesthesiology and Surgical Intensive Care Unit
| | - Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lai Jiang
- Department of Anesthesiology and Surgical Intensive Care Unit
| | - Yanfei Mao
- Department of Anesthesiology and Surgical Intensive Care Unit
| |
Collapse
|
3
|
Asman P, Pellizzer G, Tummala S, Tasnim I, Bastos D, Bhavsar S, Prabhu S, Ince NF. Long-latency gamma modulation after median nerve stimulation delineates the central sulcus and contrasts the states of consciousness. Clin Neurophysiol 2023; 145:1-10. [PMID: 36370685 DOI: 10.1016/j.clinph.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate the functional use of sub-band modulations in somatosensory evoked potentials (SSEPs) to discriminate between the primary somatosensory (S1) and motor (M1) areas and contrast the states of consciousness. METHODS During routine intraoperative cortical mapping, SSEPs were recorded with electrocorticography (ECoG) grids from the sensorimotor cortex of eight patients in the anesthetized and awake states. We conducted a time-frequency analysis on the SSEP trace to extract the spectral modulations in each state and visualize their spatial topography. RESULTS We observed late gamma modulation (60-250 Hz) in all subjects approximately 50 ms after stimulation onset, extending up to 250 ms in each state. The late gamma activity enhancement was predominant in S1 in the awake state, where it discriminated S1 from M1 at a higher accuracy (92 %) than in the anesthetized state (accuracy = 70 %). CONCLUSIONS These results showed that sensorimotor mapping does not need to rely on only SSEP phase reversal. The long latency gamma modulation can serve as a biomarker for primary sensorimotor localization and monitor the level of consciousness in neurosurgical practice. SIGNIFICANCE While the intraoperative assessment of SSEP phase reversal with ECoG is widely employed to delineate the central sulcus, the median nerve stimulation-induced spatio-spectral patterns can distinctly localize it and distinguish between conscious states.
Collapse
Affiliation(s)
- Priscella Asman
- Biomedical Engineering Department, University of Houston, Houston, TX, USA
| | - Giuseppe Pellizzer
- Research Service, Minneapolis VA Health Care System, and Departments of Neurology, and of Neuroscience, University of Minnesota, Minnesota, MN, USA
| | - Sudhakar Tummala
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Israt Tasnim
- Biomedical Engineering Department, University of Houston, Houston, TX, USA
| | - Dhiego Bastos
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Shreyas Bhavsar
- Department of Anesthesiology and Perioperative Medicine, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Sujit Prabhu
- Department of Neurosurgery, UT MD Anderson Cancer Center, Houston, TX, USA
| | - Nuri F Ince
- Biomedical Engineering Department, University of Houston, Houston, TX, USA.
| |
Collapse
|
4
|
Pasquali C, Basaldella F, Sala F. Updates on Intraoperative Neurophysiology During Surgery for Spinal Dysraphism. Adv Tech Stand Neurosurg 2023; 47:235-272. [PMID: 37640878 DOI: 10.1007/978-3-031-34981-2_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Spinal dysraphism is a group of disorders resulting from an embryologic failure of spinal cord development which can lead to a radicular-medullary mechanical stretch that generates vascular compromise and hypoxic-ischemic damage to the nervous structures of the conus-cauda region.Thus, the clinical relevance of the different types of spinal dysraphism is related to the possible neurologic deficits resulting from spinal cord tethering. The clinical presentation is heterogenous: from asymptomatic to very compromised patients. The indications and the time of a detethering surgery are still subject of debate, although there is an agreement on the high standards of treatment that have to be offered by the surgery. Intraoperative neurophysiology (ION) contributes to the safety of tethered cord surgery in reducing the risks of iatrogenic neurological damages.
Collapse
Affiliation(s)
- Claudia Pasquali
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy
| | - Federica Basaldella
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy
| | - Francesco Sala
- Section of Neurosurgery, Department of Neurosciences, Biomedicine and Movement Sciences, University Hospital, Verona, Italy.
| |
Collapse
|
5
|
Kumar KS, Sebastian J. Neuroanaesthesia: should volatile anaesthetics or total intravenous anaesthesia be used? Br J Hosp Med (Lond) 2022; 83:1-2. [DOI: 10.12968/hmed.2022.0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The choice of anaesthesia technique for neurosurgical procedures has always been debatable. Despite the well-known effects of volatile anaesthetics on intracranial pressure, these are still widely used. This article explores the advantages and disadvantages of using volatile or total intravenous anaesthesia in patients undergoing neurosurgery.
Collapse
Affiliation(s)
- Kavita Sasi Kumar
- Department of Anaesthesia, Manchester Royal Infirmary, Manchester, UK
| | | |
Collapse
|
6
|
Chandran R, De Sousa K, Koo SH, Lim YY, Shang L, Paiputra F, Tan JH, Ching TTH, Khoo X. A device to detect leakage at the patient end of total intravenous anaesthesia. J Med Eng Technol 2021; 46:95-101. [PMID: 34881660 DOI: 10.1080/03091902.2021.2006349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The use of total intravenous anaesthesia (TIVA) is limited by concerns of disconnections of the tubing, resulting in accidental awareness. We designed a sensor device to detect leakages at the patient end and notify the medical personnel, thereby allowing immediate intervention in preventing awareness. For moisture detection, resistive sensing was selected as the working principle. The prototype was in proximity to the tubing from the TIVA pump and the patient's intravenous cannula, and able to detect leakages in all potential leakage sites and activate an alarm. Our device consists of a disposable bandage (sensor), attached to a reusable clamp that is directly coupled to a central module (SparkFun MicroView, a small microcontroller with built-in Organic Light-Emitting Diode (OLED) display). The disposable bandage is wrapped around the possible leakage sites. Crucially, the disposable bandage is integrated with two separate moisture sensing threads. When moisture is present, the central module detects a drop in resistance across the moisture sensing threads and activates a flashing LED and buzzer. We have successfully created a functional leak detection device, comprising a moisture sensing bandage and an audio and visual alert system, to address the problem of undetected TIVA leakages at the patient end.
Collapse
Affiliation(s)
- Rajkumar Chandran
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore, Singapore
| | - Kalindi De Sousa
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, Singapore, Singapore
| | - Yin Yu Lim
- Ministry of Health Holdings, Singapore, Singapore
| | - Lei Shang
- Ministry of Health Holdings, Singapore, Singapore
| | - Fleming Paiputra
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Joanne Huishan Tan
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Terry Tsz Him Ching
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore
| | - Xiaojuan Khoo
- Pillar of Engineering Product Development, Singapore University of Technology and Design, Singapore, Singapore.,Science, Mathematics and Technology, Singapore University of Technology and Design, Singapore, Singapore
| |
Collapse
|
7
|
Öterkuş M, Dönmez İ, Nadir AH, Rencüzoğulları İ, Karabağ Y, Binnetoğlu K. The effect of low flow anesthesia on hemodynamic and peripheral oxygenation parameters in obesity surgery. Saudi Med J 2021; 42:264-269. [PMID: 33632904 PMCID: PMC7989260 DOI: 10.15537/smj.2021.42.3.20200575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/24/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: To investigate the effects of low-flow anesthesia on hemodynamic parameters and recovery from anesthesia in obese individuals undergoing laparoscopic surgery. Methods: This randomized-controlled and prospective study included 44 obese patients who underwent laparoscopic sleeve gastrectomy operation. The patients were randomly allocated into 2 groups as low-flow and high-flow anesthesia. Further, the groups compared in terms of hemodynamic parameters, anesthesia recovery times, operation times, and arterial blood gas parameters. Results: The groups were similar with respect to demographic data. Heart rate, peripheral oxygen saturation, arterial blood pressure measurements, end-tidal, and CO2, lactate levels measurements were similar in both groups during the entire procedure. There was also no statistically significant difference in terms of arterial blood gas parameters or anesthesia recovery periods. Conclusion: Low-flow anesthesia in laparoscopic obesity surgery seems to be safer compared to high-flow anesthesia in terms of the adequacy of tissue perfusion, depth of anesthesia, and postoperative recovery.
Collapse
Affiliation(s)
- Mesut Öterkuş
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
- Address correspondence and reprint request to: Dr. Mesut Öterkuş, Assistant Professor, Department of Anesthesiology and Reanimation, Faculty of Medicine, Malatya Turgut Özal University, Malatya, Turkey. E-mail: ORCID ID: http://orcid.org/0000-0003-1025-7662
| | - İlksen Dönmez
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Aysu H. Nadir
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - İbrahim Rencüzoğulları
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Yavuz Karabağ
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| | - Kenan Binnetoğlu
- From the Department of Anesthesiology and Reanimation (Öterkuş), Faculty of Medicine, Malatya Turgut Özal University, Malatya; from the Department of Anesthesiology and Reanimation (Dönmez), Beyoglu Eye Training and Research Hospital, İstanbul; from the Department of Anesthesiology and Reanimation (Nadir), Izmir Katip Celebi University Ataturk Training and Research Hospital, İzmir; and from the Department of Cardiology (Rencüzoğulları, Karabağ), Department of General Surgery (Binnetoğlu), Medical Faculty, Kafkas University, Kars, Turkey.
| |
Collapse
|