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Stendall C, Bowes L, Carver E. Anaesthesia for paediatric neurosurgery. Part 2: common neurosurgical procedures in children. BJA Educ 2024; 24:39-45. [PMID: 38304070 PMCID: PMC10829086 DOI: 10.1016/j.bjae.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 02/03/2024] Open
Affiliation(s)
- C. Stendall
- Birmingham Children's Hospital, Birmingham, UK
| | - L. Bowes
- Birmingham Children's Hospital, Birmingham, UK
| | - E. Carver
- Birmingham Children's Hospital, Birmingham, UK
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2
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Sharma S, Nouri MN, St-Laurent A, Wiedermann J. Vagal nerve stimulator-associated sleep disordered breathing secondary to vagal-induced laryngospasm in pediatric populations: Case presentation and systematic review. Int J Pediatr Otorhinolaryngol 2023; 173:111701. [PMID: 37643554 DOI: 10.1016/j.ijporl.2023.111701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES Sleep disordered breathing (SDB) is a well-documented complication of vagus nerve stimulation (VNS) in the literature. Yet, a formal consensus on its management has not been established, particularly in the pediatric population. This study aims to evaluate the current literature on VNS-associated SDB in order to further characterize its presentation, pathogenesis, diagnosis, and treatment. METHODS A literature review from 2001 to November 8, 2021 was conducted to search for studies on SDB during vagal nerve stimulation in pediatric populations. RESULTS Of 277 studies screened, seven studies reported on pediatric patients with VNS-associated SDB. Several investigators found on polysomnogram that periods of apnea/hypopnea correlated with VNS activity. When VNS settings were lowered or turned off, symptoms would either improve or completely resolve. CONCLUSION VNS-associated SDB is a well described complication of VNS implantation, occurring due to an obstructive process from vagal stimulation and laryngeal contraction. Diagnosis can be made via polysomnogram. Recommended treatment is through adjustment of VNS settings. However, those who are unable to tolerate this, or who have had pre-existing obstructive issues prior to VNS, should pursue other treatment options such as non-invasive positive pressure or surgery directed by DISE findings.
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Affiliation(s)
- Shreya Sharma
- Department of Otolaryngology, Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Maryam Nabavi Nouri
- Department of Pediatrics, Children's Hospital, Western University, London, Ontario, Canada; Division of Pediatric Neurology, Children's Hospital, London, Ontorio, Canada
| | - Aaron St-Laurent
- Department of Pediatrics, Children's Hospital, Western University, London, Ontario, Canada; Division of Respiratory Medicine, Children's Hospital, London, Ontario, Canada
| | - Joshua Wiedermann
- Department of Otolaryngology, Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
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Shao P, Li H, Jiang J, Guan Y, Chen X, Wang Y. Role of Vagus Nerve Stimulation in the Treatment of Chronic Pain. Neuroimmunomodulation 2023; 30:167-183. [PMID: 37369181 PMCID: PMC10614462 DOI: 10.1159/000531626] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Vagus nerve stimulation (VNS) can modulate vagal activity and neuro-immune communication. Human and animal studies have provided growing evidence that VNS can produce analgesic effects in addition to alleviating refractory epilepsy and depression. The vagus nerve (VN) projects to many brain regions related to pain processing, which can be affected by VNS. In addition to neural regulation, the anti-inflammatory property of VNS may also contribute to its pain-inhibitory effects. To date, both invasive and noninvasive VNS devices have been developed, with noninvasive devices including transcutaneous stimulation of auricular VN or carotid VN that are undergoing many clinical trials for chronic pain treatment. This review aimed to provide an update on both preclinical and clinical studies of VNS in the management for chronic pain, including fibromyalgia, abdominal pain, and headaches. We further discuss potential underlying mechanisms for VNS to inhibit chronic pain.
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Affiliation(s)
- Peiqi Shao
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huili Li
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Jia Jiang
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yun Guan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Xueming Chen
- Department of Orthopedics, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yun Wang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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4
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Perioperative Management of Nonorthopaedic Devices in the Pediatric Neuromuscular Patient Population. J Am Acad Orthop Surg 2023; 31:e403-e411. [PMID: 36853883 DOI: 10.5435/jaaos-d-22-00634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/25/2023] [Indexed: 03/01/2023] Open
Abstract
Pediatric patients with neuromuscular conditions often have nonorthopaedic implants that can pose a challenge for MRI acquisition and surgical planning. Treating physicians often find themselves in the position of navigating between seemingly overly risk-averse manufacturer's guidelines and an individual patient's benefits of an MRI or surgery. Most nonorthopaedic implants are compatible with MRI under specific conditions, though often require reprogramming or interrogation before and/or after the scan. For surgical procedures, the use of electrosurgical instrumentation poses a risk of electromagnetic interference and implants are thus often programmed or turned off for the procedures. Special considerations are needed for these patients to prevent device damage or malfunction, which can pose additional risk to the patient. Additional planning before surgery is necessary to ensure appropriate equipment, and staff are available to ensure patient safety.
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Yeap TB, Ab Mukmin L, Ang SY, Ghani AR. Perianaesthetic challenges in patients undergoing vagus nerve stimulation (VNS) placement. BMJ Case Rep 2023; 16:e252692. [PMID: 36750294 PMCID: PMC9906277 DOI: 10.1136/bcr-2022-252692] [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: 02/09/2023] Open
Abstract
Patients with medically refractory epilepsy (MRE) are indicated for vagus nerve stimulation (VNS) placement. Anaesthesia for VNS placement is extremely challenging and requires several considerations. We present a man in his 20s with MRE who successfully underwent VNS placement. We review the mechanism of action of VNS, anaesthetic challenges and measures to prevent seizures.
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Affiliation(s)
- Tat Boon Yeap
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Laila Ab Mukmin
- Department of Anaesthesia and Intensive Care Unit, Hospital Universiti Sains Malaysia, Kota Bahru, Malaysia
| | - Song Yee Ang
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kota Bahru, Malaysia
| | - Ab Rahman Ghani
- Department of Neurosciences, School of Medical Sciences, Hospital Universiti Sains Malaysia, Kota Bahru, Malaysia
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Lundstrom BN, Lin C, Starnes DK, Middlebrooks EH, Tatum W, Grewal SS, Crepeau AZ, Gregg NM, Miller KJ, Van Gompel JJ, Watson RE. Safety and Management of Implanted Epilepsy Devices for Imaging and Surgery. Mayo Clin Proc 2022; 97:2123-2138. [PMID: 36210199 PMCID: PMC9888397 DOI: 10.1016/j.mayocp.2022.06.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/13/2022] [Accepted: 06/13/2022] [Indexed: 11/05/2022]
Abstract
Permanently implanted devices that deliver electrical stimulation are increasingly used to treat patients with drug-resistant epilepsy. Primary care physicians, neurologists, and epilepsy clinicians may encounter patients with a variety of implanted neuromodulation devices in the course of clinical care. Due to the rapidly changing landscape of available epilepsy-related neurostimulators, there may be uncertainty related to how these devices should be handled during imaging procedures and perioperative care. We review the safety and management of epilepsy-related implanted neurostimulators that may be encountered during imaging and surgery. We provide a summary of approved device labeling and recommendations for the practical management of these devices to help guide clinicians as they care for patients treated with bioelectronic medicine.
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Affiliation(s)
| | - Chen Lin
- Department of Radiology, Mayo Clinic, Jacksonville, FL
| | | | | | - William Tatum
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | | | - Amy Z Crepeau
- Department of Neurology, Mayo Clinic, Scottsdale, AZ
| | | | - Kai J Miller
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
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7
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Miron G, Strauss I, Fried I, Fahoum F. Anterior thalamic deep brain stimulation in epilepsy patients refractory to vagus nerve stimulation: A single center observational study. Epilepsy Behav Rep 2022; 20:100563. [PMID: 36119948 PMCID: PMC9471437 DOI: 10.1016/j.ebr.2022.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/10/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022] Open
Abstract
Patients with drug resistant epilepsy refractory to treatment with vagal nerve stimulation benefited from anterior thalamic deep brain stimulation. We report a combined neuromodulation approach of simultaneous vagal nerve and deep brain stimulation. Additional studies are needed to assess safety and efficacy of simultaneous VNS and DBS treatment.
Anterior thalamic deep brain stimulation (DBS) is a palliative treatment that may be considered in patients with drug resistant epilepsy (DRE) that fail treatment with vagus nerve stimulation (VNS). Combining VNS and DBS treatment is a therapeutic approach rarely reported. This single center observational study aims to describe response to DBS treatment in 11 epilepsy patients resistant to medications and VNS. Patients either had inactivated VNS (DBS only) or were treated with simultaneous DBS and VNS (DBS-VNS). Focal impaired awareness (FIA) and most disabling seizure rates were examined pre-DBS implantation, 3 months following implantation, and last follow up. Overall, a decrease in FIA (47.0 ± 30.7 %, p = 0.02) and most disabling seizure rate (54.8 ± 34.2 %, p = 0.03) was seen at last follow-up (average follow-up 28.5 ± 13.5 months). Eight of 11 patients were DBS responders (most disabling seizure rate reduction above 50%). No difference in seizure control was found between seven DBS only and four DBS-VNS patients. Our results argue that patients who have failed antiseizure medication and VNS therapies, could benefit from better seizure control if treated with adjunctive DBS. Larger prospective studies are needed to assess the efficacy and safety of combined neurostimulation treatments in DRE.
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Michalowski A, Haines A, Shaparin N, Gritsenko K, Kaye AD, Cornett EM, Lerner MZ. Transcutaneous Electrical Nerve Stimulation as a Treatment for Neuropathic Cough: A Tolerability and Feasibility Study. Neurol Ther 2021; 10:1127-1133. [PMID: 34002358 PMCID: PMC8571432 DOI: 10.1007/s40120-021-00255-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/01/2021] [Indexed: 12/24/2022] Open
Abstract
Transcutaneous electrical nerve stimulation (TENS) is a form of electroanalgesia used for neuropathic pain disorders. Refractory chronic cough, or “neuropathic cough,” may be physiologically similar to other neuropathic pain conditions. This study explored the tolerability and feasibility of using TENS as a treatment for neuropathic cough. Laryngeal TENS was administered to five subjects with neuropathic cough. One electrode was placed over the lateral thyrohyoid membrane, and a second over the cricothyroid space. A frequency of 120 Hz was applied for 30 min. Participants rated symptoms pre-, during, and post-TENS treatment using a Likert scale. Laryngeal TENS was well tolerated by all subjects. Adverse effects included brief neck discomfort when increasing TENS intensity and an event of mild post-treatment hoarseness. The self-reported scores trended toward a reduction in symptom severity during and after treatment. Controlled trials using this method would elucidate the use of TENS for treatment of patients suffering from chronic cough.
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Affiliation(s)
| | - Adam Haines
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Naum Shaparin
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karina Gritsenko
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, Shreveport, LA, USA
| | - Michael Z Lerner
- Division of Otolaryngology, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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Lee KJ, Manepalli A, Tollinche LE, Yeoh CB. Unusual Cause of Intraoperative Asystole During Thoracotomy: A Case Report. A A Pract 2021; 15:e01469. [PMID: 33999865 PMCID: PMC8162391 DOI: 10.1213/xaa.0000000000001469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thoracotomies are classified as moderate to high-risk surgeries due to the preponderance of complex anatomic structures, cardiac dysrhythmias, and respiratory insufficiency. The right vagus nerve innervates the sinoatrial node and controls the heart rate. The parasympathetic activation of the sinoatrial node can lead to bradyarrhythmias. The anatomic aortopulmonary window contains lymph nodes and the left vagus nerve. The occurrence of sudden asystole due to left vagus nerve stimulation is extremely rare. We report an unusual case of intraoperative asystole related to electrosurgical stimulation of the left vagus nerve that required cardiopulmonary resuscitation and cardiac massage.
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Affiliation(s)
- Kathleen J Lee
- From the Department of Anesthesiology and Pain Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ashok Manepalli
- Department of Anesthesiology, University at Buffalo, Buffalo, New York
| | - Luis E Tollinche
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cindy B Yeoh
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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10
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Crawford L, Mueller D, Mathews L. Anesthetic Considerations for Functional Neurosurgery. Anesthesiol Clin 2021; 39:227-243. [PMID: 33563384 DOI: 10.1016/j.anclin.2020.11.013] [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: 11/29/2022]
Abstract
Functional neurosurgery is a rapidly growing field that uses surgical resection, ablation, or neuromodulation to treat an assortment of neurologic and psychiatric disorders, the most common of which are movement disorders and epilepsy. Anesthesiologists caring for patients undergoing neurofunctional procedures should be aware of the anesthetic implications of patients' underlying disease as well as procedure-specific concerns, such as the effects of anesthetics on intraoperative neuromonitoring and limited access to patients due to stereotactic frames or intraoperative imaging.
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Affiliation(s)
- Lane Crawford
- Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232, USA.
| | - Dorothee Mueller
- Department of Anesthesiology, Vanderbilt University Medical Center, 1211 21st Ave S, 422 MAB, Nashville, TN 37212, USA
| | - Letha Mathews
- Department of Anesthesiology, Vanderbilt University Medical Center, 1301 Medical Center Drive, 4648 TVC, Nashville, TN 37232, USA
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Chyan A, Kumaraswami S, Pothula S. Management of a parturient with seizure disorder and a vagus nerve stimulator. J Clin Anesth 2021; 71:110193. [PMID: 33578202 DOI: 10.1016/j.jclinane.2021.110193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Arthur Chyan
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
| | - Sangeeta Kumaraswami
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA.
| | - Suryanarayana Pothula
- Department of Anesthesiology, New York Medical College, Westchester Medical Center, Valhalla, NY, USA
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12
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Florie MGMH, Pilz W, Dijkman RH, Kremer B, Wiersma A, Winkens B, Baijens LWJ. The Effect of Cranial Nerve Stimulation on Swallowing: A Systematic Review. Dysphagia 2020; 36:216-230. [PMID: 32410202 PMCID: PMC8004503 DOI: 10.1007/s00455-020-10126-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 05/02/2020] [Indexed: 01/09/2023]
Abstract
This systematic review summarizes published studies on the effect of cranial nerve stimulation (CNS) on swallowing and determines the level of evidence of the included studies to guide the development of future research on new treatment strategies for oropharyngeal dysphagia (OD) using CNS. Studies published between January 1990 and October 2019 were found via a systematic comprehensive electronic database search using PubMed, Embase, and the Cochrane Library. Two independent reviewers screened all articles based on the title and abstract using strict inclusion criteria. They independently screened the full text of this initial set of articles. The level of evidence of the included studies was assessed independently by the two reviewers using the A-B-C rating scale. In total, 3267 articles were found in the databases. In the majority of these studies, CNS was used for treatment-resistant depression or intractable epilepsy. Finally, twenty-eight studies were included; seven studies on treatment of depression, thirteen on epilepsy, and eight on heterogeneous indications. Of these, eight studies reported the effects of CNS on swallowing and in 20 studies the swallowing outcome was described as an adverse reaction. A meta-analysis could not be carried out due to the poor methodological quality and heterogeneity of study designs of the included studies. These preliminary data suggest that specific well-indicated CNS might be effective in reducing OD symptoms in selective patient groups. But it is much too early for conclusive statements on this topic. In conclusion, the results of these studies are encouraging for future research on CNS for OD. However, randomized, double-blind, sham-controlled clinical trials with sufficiently large sample sizes are necessary.
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Affiliation(s)
- Michelle G M H Florie
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,School for Mental Health and Neuroscience - MHeNs, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Remco H Dijkman
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anke Wiersma
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI - Care and Public Health Research Institute, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Bhat A, Graham AR, Trivedi H, Hogan MK, Horner PJ, Guiseppi-Elie A. Engineering the ABIO-BIO interface of neurostimulation electrodes using polypyrrole and bioactive hydrogels. PURE APPL CHEM 2020. [DOI: 10.1515/pac-2019-1107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Following spinal cord injury, the use of electrodes for neurostimulation in animal models has been shown to stimulate muscle movement, however, the efficacy of such treatment is impaired by increased interfacial impedance caused by fibrous encapsulation of the electrode. Sputter-deposited gold-on-polyimide electrodes were modified by potentiostatic electrodeposition of poly(pyrrole-co-3-pyrrolylbutyrate-conj-aminoethylmethacrylate): sulfopropyl methacrylate [P(Py-co-PyBA-conj-AEMA):SPMA] to various charge densities (0–100 mC/cm2) to address interfacial impedance and coated with a phosphoryl choline containing bioactive hydrogel to address biocompatibility at the ABIO-BIO interface. Electrodes were characterized with scanning electron microscopy (surface morphology), multiple-scan rate cyclic voltammetry (peak current and electroactive area), and electrochemical impedance spectroscopy (charge transfer resistance and membrane resistance). SEM analysis and electroactive area calculations identified films fabricated with a charge density of 50 mC/cm2 as well suited for neurostimulation electrodes. Charge transfer resistance demonstrated a strong inverse correlation (−0.83) with charge density of electrodeposition. On average, the addition of polypyrrole and hydrogel to neurostimulation electrodes decreased charge transfer resistance by 82 %. These results support the use of interfacial engineering techniques to mitigate high interfacial impedance and combat the foreign body response towards epidurally implanted neurostimulation electrodes.
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Affiliation(s)
- Ankita Bhat
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering , Texas A&M University , College Station, TX 77843 , USA
| | - Alexa R. Graham
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering , Texas A&M University , College Station, TX 77843 , USA
| | - Hemang Trivedi
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
| | - Matthew K. Hogan
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
| | - Philip J. Horner
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
| | - Anthony Guiseppi-Elie
- Center for Bioelectronics, Biosensors and Biochips (C3B), Department of Biomedical Engineering , Texas A&M University , College Station, TX 77843 , USA
- Houston Methodist Institute for Academic Medicine and Houston Methodist Research Institute , 6670 Bertner Ave. , Houston, TX 77030 , USA
- Department of Electrical and Computer Engineering , Texas A&M University , College Station, TX 77843 , USA
- ABTECH Scientific, Inc., Biotechnology Research Park , 800 East Leigh Street , Richmond, VA 23219 , USA , Tel.: +1(979) 458 1239, Fax: +1(979) 845 4450
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Abstract
BACKGROUND Medical cannabis has recently emerged as a treatment option for children with drug-resistant epilepsy. Despite the fact that many pediatric epilepsy patients across Canada are currently being treated with cannabis, little is known about the attitudes of neurologists toward cannabinoid treatment of children with epilepsy. METHODS A 21-item online survey was distributed via email to 148 pediatric neurologists working in hospitals and community clinics across Canada. Questions were related to clinical practice and demographics. RESULTS This survey achieved a response rate of 38% (56 Canadian neurologists). These neurologists were treating 668 pediatric epilepsy patients with cannabinoids. While 29% of neurologists did not support cannabis treatment in their patients, 34% prescribed cannabis, and 38% referred to another authorizing physician, mostly to community-based non-neurologists. The majority of neurologists considered cannabis for patients with Dravet syndrome (68%) and Lennox-Gastaut syndrome (64%) after an average of three failed anticonvulsants. Twenty-seven percent considered it for patients with idiopathic generalized epilepsy, and 18% for focal epilepsy. No neurologist used cannabis as a first-line treatment. All neurologists had at least one hesitation regarding cannabis treatment in pediatric epilepsy. The most common one was poor evidence (66%), followed by poor quality control (52%) and high cost (50%). CONCLUSIONS The majority of Canadian pediatric neurologists consider using cannabis as a treatment for epilepsy in children. With many gaps in evidence and high patient-driven demand for cannabis therapy, this survey provides immediate information from the "wisdom of the crowd," to aid neurologists until further evidence is available.
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Pacemakers, Deep Brain Stimulators, Cochlear Implants, and Nerve Stimulators: A Review of Common Devices Encountered in the Dermatologic Surgery Patient. Dermatol Surg 2020; 45:1228-1236. [PMID: 31318829 DOI: 10.1097/dss.0000000000002012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In dermatologic and procedural surgery settings, there are commonly encountered devices in patients. Safe surgical planning requires familiarity with these devices. OBJECTIVE To review the current implanted devices in patients and recommendations for surgical planning around these devices. METHODS AND MATERIALS A comprehensive review using PubMed and published device recommendations was performed, searching for those most relevant to dermatologic surgery. RESULTS Devices such as pacemakers and implantable cardiac defibrillators, deep brain stimulators, cochlear implants, and various nerve stimulators are potential devices that may be encountered in patients and specific recommendations exist for each of these devices. CONCLUSION Dermatologic surgeons' knowledge of implanted devices in patients is paramout to safe surgical procedures.
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Suer M, Abd-Elsayed A. Patient with a Vagal Nerve Stimulator. GUIDE TO THE INPATIENT PAIN CONSULT 2020:45-56. [DOI: 10.1007/978-3-030-40449-9_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Syncope after administration of epidural analgesia in an obstetric patient with a vagus nerve stimulator. Int J Obstet Anesth 2019; 38:134-137. [DOI: 10.1016/j.ijoa.2018.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 12/20/2018] [Accepted: 12/31/2018] [Indexed: 01/27/2023]
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Stieglitz T. Why Neurotechnologies? About the Purposes, Opportunities and Limitations of Neurotechnologies in Clinical Applications. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09406-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractNeurotechnologies describe a field of science and engineering in which the nervous system is interfaced with technical devices. Fundamental research is conducted to explore functions of the brain, decipher the neural code and get a better understanding of diseases and disorders. Risk benefit assessment has been well established in all medical disciplines to treat patients best possible while minimizing jeopardizing their lives by the interventions. Is this set of assessment rules sufficient when the brain will be interfaced with a technical system and is this assessment enough? How will these new technologies change personality and society? This article will shortly review different stakeholders’ opinions and their expectation in the field, assembles information the state-of-the art in medical applications of neurotechnological implants and describes and assesses the fundamental technologies that are used to build up these implants starting with essential requirements of technical materials in contact with living tissue. The different paragraphs guide the reader through the main aspects of neurotechnologies and lay a foundation of knowledge to be able to contribute to the discussion in which cases implants will be beneficial and in which cases we should express serious concerns.
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Haney MM, Ericsson AC, Lever TE. Effects of Intraoperative Vagal Nerve Stimulation on the Gastrointestinal Microbiome in a Mouse Model of Amyotrophic Lateral Sclerosis. Comp Med 2018; 68:452-460. [PMID: 30424824 DOI: 10.30802/aalas-cm-18-000039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The gastrointestinal microbiota (GM) plays a fundamental role in health and disease and contributes to the bidirectional signaling between the gastrointestinal system and brain. The direct line of communication between these organ systems is through the vagus nerve. Therefore, vagal nerve stimulation (VNS), a commonly used technique for multiple disorders, has potential to modulate the enteric microbiota, enabling investigation and possibly treatment of numerous neurologic disorders in which the microbiota has been linked with disease. Here we investigate the effect of VNS in a mouse model of amyotrophic lateral sclerosis (ALS). B6SJL-Tg(SOD1*G93A)dl1Gur (SOD1dl) and wildtype mice underwent ventral neck surgery to access the vagus nerve. During surgery, the experimental group received 1 h of VNS, whereas the sham group underwent 1 h of sham treatment. The third (control) group did not undergo any surgical manipulation. Fecal samples were collected before surgery and at 8 d after the initial collection. Microbial DNA was sequenced to determine the GM profiles at both time points. GM profiles did not differ between genotypes at either the initial or end point. In addition, VNS did not alter GM populations, according to the parameters chosen in this study, indicating that this short intraoperative treatment is safe and has no lasting effects on the GM. Future studies are warranted to determine whether different stimulation parameters or chronic use of VNS affect GM profiles.
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Affiliation(s)
- Megan M Haney
- Metagenomics Center, University of Missouri, Columbia, Missouri, USA.
| | - Aaron C Ericsson
- Metagenomics Center, University of Missouri, Columbia, Missouri, USA
| | - Teresa E Lever
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri, Columbia, Missouri, USA
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Kalita J, Kumar S. Commentary: Similar philosophy does not always synchronize. Ann Card Anaesth 2018; 21:60. [PMID: 29336394 PMCID: PMC5791491 DOI: 10.4103/aca.aca_200_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jayanthi Kalita
- Department of Neurology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
| | - S Kumar
- Department of Neurology, Sanjay Gandhi PGIMS, Lucknow, Uttar Pradesh, India
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Abstract
The prevalence of epilepsy worldwide is around 0.5%-2% of the population. Antiepileptic medications are the first line of treatment in most of the cases but approximately 25%-30% epilepsy patients are refractory to the single or combination therapy. The surgical option for temporal lobe epilepsy is temporal lobectomy, which has its inherent risk of neurological deficits after the surgery. Patients who are either refractory to combination therapy or do not want surgical temporal lobectomy are the candidates for electrical stimulation therapy. Refractory cases require implantable device such as vagal nerve stimulator (VNS). We are reporting perioperative management of a patient, with an implanted VNS, posted for pericardiectomy. It is important for the anesthesiologist to be familiar with the mechanism of VNS for proper perioperative care.
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Affiliation(s)
- Aashish Jain
- Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurugram, Haryana, India
| | - Dheeraj Arora
- Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurugram, Haryana, India
| | - Yatin Mehta
- Medanta Institute of Critical Care and Anesthesiology, Medanta The Medicity, Gurugram, Haryana, India
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Mishra SK, Choudhury S. Experimental Protocol for Cecal Ligation and Puncture Model of Polymicrobial Sepsis and Assessment of Vascular Functions in Mice. Methods Mol Biol 2018; 1717:161-187. [PMID: 29468592 DOI: 10.1007/978-1-4939-7526-6_14] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sepsis is the systemic inflammatory response syndrome that occurs during infection and is exacerbated by the inappropriate immune response encountered by the affected individual. Despite extensive research, sepsis in humans is one of the biggest challenges for clinicians. The high mortality rate in sepsis is primarily due to hypoperfusion-induced multiorgan dysfunctions , resulting from a marked decrease in peripheral resistance. Vascular dysfunctions are further aggravated by sepsis-induced impairment in myocardial contractility. Circulatory failure in sepsis is characterized by refractory hypotension and vascular hyporeactivity (vasoplegia) to clinically used vasoconstrictors. To investigate the complex pathophysiology of sepsis and its associated multiple organ dysfunction, several animal models have been developed. However, cecal ligation and puncture (CLP) model of murine sepsis is still considered as 'gold standard' in sepsis research. In this protocol we have described the standard surgical procedure to induce polymicrobial sepsis by cecal ligation and puncture. Further, we have described the protocol to study the molecular mechanisms underlying vascular dysfunctions in sepsis.
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Affiliation(s)
- Santosh Kumar Mishra
- Division of Pharmacology & Toxicology, Indian Veterinary Research Institute, Bareilly, Uttar Pradesh, India.
- , Bhubaneswar, Odisha, India.
| | - Soumen Choudhury
- Department of Pharmacology and Toxicology, College of Veterinary Science & Animal Husbandry, U.P. Pandit Deen Dayal Upadhyaya Pashu Chikitsa Vigyan Vishwavidyalaya Evam Go-Anusandhan Sansthan, Mathura, Uttar Pradesh, India
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Giordano F, Zicca A, Barba C, Guerrini R, Genitori L. Vagus nerve stimulation: Surgical technique of implantation and revision and related morbidity. Epilepsia 2017; 58 Suppl 1:85-90. [DOI: 10.1111/epi.13678] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Flavio Giordano
- Department of Neurosurgery; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Anna Zicca
- Department of Neuroanaesthesiology; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Carmen Barba
- Pediatric Neurology Unit; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Renzo Guerrini
- Pediatric Neurology Unit; Anna Meyer Hospital; University of Firenze; Firenze Italy
| | - Lorenzo Genitori
- Department of Neurosurgery; Anna Meyer Hospital; University of Firenze; Firenze Italy
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Effects of short and prolonged transcutaneous vagus nerve stimulation on heart rate variability in healthy subjects. Auton Neurosci 2017; 203:88-96. [DOI: 10.1016/j.autneu.2016.11.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 10/19/2016] [Accepted: 11/25/2016] [Indexed: 01/14/2023]
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Sahyouni R, Chang DT, Moshtaghi O, Mahmoodi A, Djalilian HR, Lin HW. Functional and Histological Effects of Chronic Neural Electrode Implantation. Laryngoscope Investig Otolaryngol 2017; 2:80-93. [PMID: 28894826 PMCID: PMC5527370 DOI: 10.1002/lio2.66] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 12/27/2022] Open
Abstract
Objectives Permanent injury to the cranial nerves can often result in a substantial reduction in quality of life. Novel and innovative interventions can help restore form and function in nerve paralysis, with bioelectric interfaces among the more promising of these approaches. The foreign body response is an important consideration for any bioelectric device as it influences the function and effectiveness of the implant. The purpose of this review is to describe tissue and functional effects of chronic neural implantation among the different categories of neural implants and highlight advances in peripheral and cranial nerve stimulation. Data Sources: PubMed, IEEE, and Web of Science literature search. Review Methods: A review of the current literature was conducted to examine functional and histologic effects of bioelectric interfaces for neural implants. Results Bioelectric devices can be characterized as intraneural, epineural, perineural, intranuclear, or cortical depending on their placement relative to nerves and neuronal cell bodies. Such devices include nerve‐specific stimulators, neuroprosthetics, brainstem implants, and deep brain stimulators. Regardless of electrode location and interface type, acute and chronic histological, macroscopic and functional changes can occur as a result of both passive and active tissue responses to the bioelectric implant. Conclusion A variety of chronically implantable electrodes have been developed to treat disorders of the peripheral and cranial nerves, to varying degrees of efficacy. Consideration and mitigation of detrimental effects at the neural interface with further optimization of functional nerve stimulation will facilitate the development of these technologies and translation to the clinic. Level of Evidence 3.
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Affiliation(s)
- Ronald Sahyouni
- Department of Biomedical Engineering, University of California Irvine U.S.A
| | - David T Chang
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A.,Division of Otolaryngology-Head &Neck Surgery, Irvine, California, Children's Hospital of Orange County Orange California U.S.A
| | - Omid Moshtaghi
- School of Medicine, University of California Irvine U.S.A
| | - Amin Mahmoodi
- Department of Biomedical Engineering, University of California Irvine U.S.A
| | - Hamid R Djalilian
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A
| | - Harrison W Lin
- Department of Otolaryngology-Head & Neck Surgery, University of California Irvine U.S.A
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Gastric acid secretion and gastrin release during continuous vagal neuromonitoring in thyroid surgery. Langenbecks Arch Surg 2017; 402:265-272. [DOI: 10.1007/s00423-017-1555-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
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Trezza A, Landi A, Grioni D, Pirillo D, Fiori L, Giussani C, Sganzerla EP. Adverse Effects and Surgical Complications in Pediatric Patients Undergoing Vagal Nerve Stimulation for Drug-Resistant Epilepsy. ACTA NEUROCHIRURGICA. SUPPLEMENT 2017; 124:43-47. [PMID: 28120051 DOI: 10.1007/978-3-319-39546-3_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Vagal nerve stimulation (VNS) is an effective treatment for drug-resistant epilepsy that is not suitable for resective surgery, both in adults and in children. Few reports describe the adverse effects and complications of VNS. The aim of our study was to present a series of 33 pediatric patients who underwent VNS for drug-resistant epilepsy and to discuss the adverse effects and complications through a review of the literature.The adverse effects of VNS are usually transient and are dependent on stimulation of the vagus and its efferent fibers; surgical complications of the procedure may be challenging and patients sometimes require further surgery; generally these complications affect VNS efficacy; in addition, hardware complications also have to be taken into account.In our experience and according to the literature, adverse effects and surgical and hardware complications are uncommon and can usually be managed definitely. Careful selection of patients, particularly from a respiratory and cardiac point of view, has to be done before surgery to limit the incidence of some adverse effects.
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Affiliation(s)
- A Trezza
- Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, San Gerardo Hospital, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy.
| | - A Landi
- Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, San Gerardo Hospital, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - D Grioni
- Unit of Pediatric Neurophysiology, Child Neuropsychiatric Clinic, San Gerardo Hospital, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - D Pirillo
- Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, San Gerardo Hospital, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - L Fiori
- Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, San Gerardo Hospital, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - C Giussani
- Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, San Gerardo Hospital, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy
| | - E P Sganzerla
- Neurosurgery, Department of Surgery and Translational Medicine, Milan Center for Neuroscience, San Gerardo Hospital, University of Milano Bicocca, via Pergolesi 33, 20900, Monza, Italy
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Whitney PS, Sturgess J. Anaesthetic considerations for patients with neurosurgical implants. BJA Educ 2016. [DOI: 10.1093/bjaed/mkv049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Upadhyay H, Bhat S, Gupta D, Mulvey M, Ming S. The therapeutic dilemma of vagus nerve stimulator-induced sleep disordered breathing. Ann Thorac Med 2016; 11:151-4. [PMID: 27168865 PMCID: PMC4854063 DOI: 10.4103/1817-1737.180025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intermittent vagus nerve stimulation (VNS) can reduce the frequency of seizures in patients with refractory epilepsy, but can affect respiration in sleep. Untreated obstructive sleep apnea (OSA) can worsen seizure frequency. Unfortunately, OSA and VNS-induced sleep disordered breathing (SDB) may occur in the same patient, leading to a therapeutic dilemma. We report a pediatric patient in whom OSA improved after tonsillectomy, but coexistent VNS-induced SDB persisted. With decrease in VNS output current, patient's SDB improved, but seizure activity exacerbated, which required a return to the original settings. Continuous positive airway pressure titration was attempted, which showed only a partial improvement in apnea–hypopnea index. This case illustrates the need for clinicians to balance seizure control and SDB in patients with VNS.
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Affiliation(s)
- Hinesh Upadhyay
- Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA
| | - Sushanth Bhat
- Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA
| | - Divya Gupta
- Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA
| | - Martha Mulvey
- Department of Neurosciences and Neurology, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA
| | - Sue Ming
- Sleep Disorder Center, Neuroscience Institute, JFK Medical Center, Edison, Newark, New Jersey, USA; Department of Neurosciences and Neurology, Rutgers University - New Jersey Medical School, Newark, New Jersey, USA
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Mangano A, Kim HY, Wu CW, Rausei S, Hui S, Xiaoli L, Chiang FY, Roukos DH, Lianos GD, Volpi E, Dionigi G. Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures. Head Neck 2015; 38 Suppl 1:E1568-74. [PMID: 26613871 DOI: 10.1002/hed.24280] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 07/26/2015] [Accepted: 09/09/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Continuous intraoperative neuromonitoring (C-IONM) is a new technology and it is appropriate to analyze its safety. METHODS C-IONM was performed according to a standardized technique to control any adverse events and electrode positioning issues. RESULTS Four hundred vagal nerve dissections were analyzed considering vagal nerve diameter, mean time effort for C-IONM probe positioning, and electrode dislocation rate. A significant superior dislocation rate in case of: (a) when a 3 mm automatic periodic stimulating (APS) electrode size was used in a vagal nerve diameter <2 mm; (b) anterior access; and (c) vagal nerve A subtype in relation (p < .05). No related additional local or systemic morbidity was registered in this series. There was a statistically significant positive relationship between increased diameter of vagal nerve and increased electromyography (EMG) amplitude (p = .03). There was also a significant increase of amplitude between initial and final vagal nerve stimulation in uneventful cases (p = .02). CONCLUSION We analyzed the technical issues to achieve improved vagal nerve critical view of safety dissection, stimulation, and C-IONM probe placement. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1568-E1574, 2016.
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Affiliation(s)
- Alberto Mangano
- First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital Seoul, Seoul, Korea
| | - Chei-Wei Wu
- Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Stefano Rausei
- First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
| | - Sun Hui
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China
| | - Liu Xiaoli
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China
| | - Feng-Yu Chiang
- Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Dimitrios H Roukos
- Department of General Surgery Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine Ioannina University, Ioannina, Greece
| | - Georgios D Lianos
- Department of General Surgery Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine Ioannina University, Ioannina, Greece
| | - Erivelto Volpi
- Department of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil
| | - Gianlorenzo Dionigi
- First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
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Bacuzzi A, Dralle H, Randolph GW, Chiang FY, Kim HY, Barczyński M, Dionigi G. Safety of Continuous Intraoperative Neuromonitoring (C-IONM) in Thyroid Surgery. World J Surg 2015; 40:768-9. [DOI: 10.1007/s00268-015-3288-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chakravarthy K, Chaudhry H, Williams K, Christo PJ. Review of the Uses of Vagal Nerve Stimulation in Chronic Pain Management. Curr Pain Headache Rep 2015; 19:54. [DOI: 10.1007/s11916-015-0528-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Shetty A, Pardeshi S, Shah VM, Kulkarni A. Anesthesia considerations in epilepsy surgery. Int J Surg 2015; 36:454-459. [PMID: 26188082 DOI: 10.1016/j.ijsu.2015.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/28/2015] [Accepted: 07/14/2015] [Indexed: 11/16/2022]
Abstract
Epilepsy surgeries can be done under general anesthesia or with local anesthesia and sedation. Epilepsy surgery done under general anesthesia have similar goals as any other neurosurgical procedure, except in patients with temporal lobe epilepsy requiring cortical mapping or electrocorticography (ECoG) where depth of anesthesia has to be reduced. Since seizure focus localization can be done preoperatively with modern diagnostic tools, general anesthesia is popular even for these patients. It is comfortable for both the surgeon and the patient. For intraoperative ECoG or cortical mapping awake craniotomy is the preferred technique.
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Affiliation(s)
- Anita Shetty
- Neuroanesthesia Fellowship Programme, Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India.
| | - Swarada Pardeshi
- Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Viraj M Shah
- Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Aarti Kulkarni
- Department of Anesthesia, Seth GS Medical College & KEM Hospital, Mumbai, India
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Richa F. Anaesthesia and orphan disease: a child with neuronal ceroid lipofuscinosis. Eur J Anaesthesiol 2015; 32:213-215. [PMID: 24979587 DOI: 10.1097/eja.0000000000000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Freda Richa
- From the Saint-Joseph University, Hotel-Dieu de France Hospital, Anaesthesia and Intensive Care Department, Beirut, Lebanon
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Kelts G, O'Connor PD, Hussey RW, Maturo S. An electrical cause of stridor: pediatric vagal nerve stimulators. Int J Pediatr Otorhinolaryngol 2015; 79:251-3. [PMID: 25500186 DOI: 10.1016/j.ijporl.2014.10.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 10/21/2014] [Accepted: 10/29/2014] [Indexed: 10/24/2022]
Abstract
Vagal nerve stimulators (VNS) are surgically implantable medical devices which are approved by the food and drug administration (FDA) for treatment of medically refractory epilepsy in children. Two children with seizures disorders presented to the pediatric otolaryngology clinic with complaints of stridor and sleep apnea following implantation of VNS devices. Both children were evaluated with flexible laryngoscopy, direct laryngoscopy and bronchoscopy. The children were noted to have contraction of their vocal folds and supraglottis and the settings of their VNS were adjusted until no further contractions were noted. Each child had resolution of their symptoms following adjustment.
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Affiliation(s)
- Gregory Kelts
- San Antonio Uniformed Services Health Education Consortium, Otolaryngology, United States.
| | - Peter D O'Connor
- San Antonio Uniformed Services Health Education Consortium Center, Otolaryngology, United States
| | - Richard W Hussey
- San Antonio Uniformed Services Health Education Consortium, Pediatric Neurology, United States
| | - Stephen Maturo
- San Antonio Uniformed Services Health Education Consortium, Otolaryngology, United States
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Ben-Menachem E, Revesz D, Simon BJ, Silberstein S. Surgically implanted and non-invasive vagus nerve stimulation: a review of efficacy, safety and tolerability. Eur J Neurol 2015; 22:1260-8. [PMID: 25614179 PMCID: PMC5024045 DOI: 10.1111/ene.12629] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/27/2014] [Indexed: 12/12/2022]
Abstract
Vagus nerve stimulation (VNS) is effective in refractory epilepsy and depression and is being investigated in heart failure, headache, gastric motility disorders and asthma. The first VNS device required surgical implantation of electrodes and a stimulator. Adverse events (AEs) are generally associated with implantation or continuous on-off stimulation. Infection is the most serious implantation-associated AE. Bradycardia and asystole have also been described during implantation, as has vocal cord paresis, which can last up to 6 months and depends on surgical skill and experience. The most frequent stimulation-associated AEs include voice alteration, paresthesia, cough, headache, dyspnea, pharyngitis and pain, which may require a decrease in stimulation strength or intermittent or permanent device deactivation. Newer non-invasive VNS delivery systems do not require surgery and permit patient-administered stimulation on demand. These non-invasive VNS systems improve the safety and tolerability of VNS, making it more accessible and facilitating further investigations across a wider range of uses.
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Affiliation(s)
- E Ben-Menachem
- Institution of Clinical Neuroscience and Physiology, Sahlgrenska Academy, Göteborgs University, Göteborg, Sweden
| | - D Revesz
- Institution of Clinical Neuroscience and Physiology, Sahlgrenska Academy, Göteborgs University, Göteborg, Sweden
| | - B J Simon
- electroCore LLC, Basking Ridge, NJ, USA
| | - S Silberstein
- Jefferson Headache Center, Thomas Jefferson University, Philadelphia, PA, USA
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Shah A, Carreno FR, Frazer A. Therapeutic modalities for treatment resistant depression: focus on vagal nerve stimulation and ketamine. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2014; 12:83-93. [PMID: 25191499 PMCID: PMC4153868 DOI: 10.9758/cpn.2014.12.2.83] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 03/24/2014] [Indexed: 01/11/2023]
Abstract
Treatment resistant depression (TRD) is a global health concern affecting a large proportion of depressed patients who then require novel therapeutic options. One such treatment option that has received some attention in the past several years is vagal nerve stimulation (VNS). The present review briefly describes the relevance of this treatment in the light of other existing pharmacological and non-pharmacological options. It then summarizes clinical findings with respect to the efficacy of VNS. The anatomical rationale for its efficacy and other potential mechanisms of its antidepressant effects as compared to those employed by classical antidepressant drugs are discussed. VNS has been approved in some countries and has been used for patients with TRD for quite some time. A newer, fast-acting, non-invasive pharmacological option called ketamine is currently in the limelight with reference to TRD. This drug is currently in the investigational phase but shows promise. The clinical and preclinical findings related to ketamine have also been summarized and compared with those for VNS. The role of neurotrophin factors, specifically brain derived neurotrophic factor and its receptor, in the beneficial effects of both VNS and ketamine have been highlighted. It can be concluded that both these therapeutic modalities, while effective, need further research that can reveal specific targets for intervention by novel drugs and address concerns related to side-effects, especially those seen with ketamine.
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Affiliation(s)
- Aparna Shah
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, USA
| | - Flavia Regina Carreno
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, USA
| | - Alan Frazer
- Department of Pharmacology and Center for Biomedical Neuroscience, University of Texas Health Science Center, San Antonio, TX, USA. ; South Texas Veterans Health Care System (STVHCS), Audie L. Murphy Division, San Antonio, TX, USA
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Laqua R, Leutzow B, Wendt M, Usichenko T. Transcutaneous vagal nerve stimulation may elicit anti- and pro-nociceptive effects under experimentally-induced pain - a crossover placebo-controlled investigation. Auton Neurosci 2014; 185:120-2. [PMID: 25135040 DOI: 10.1016/j.autneu.2014.07.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 07/19/2014] [Accepted: 07/29/2014] [Indexed: 01/16/2023]
Abstract
Vagal nerve stimulation is a promising method for the treatment of pain. The aim was to investigate the effect of non-invasive transcutaneous vagal nerve stimulation (TVNS) on the experimental pain threshold (PT) and to compare it with placebo. PT of standardized electrical stimulation was measured in 22 healthy male volunteers during two study sessions. TVNS was applied to the auricular concha bilaterally for 35min using 2Hz/100Hz bursts with the intensity, which was individually maximal but non-painful. During the placebo session, the volunteers received no stimulation. PT, heart rate and blood pressure were registered as outcome measures. There were no differences in PT values between TVNS and placebo conditions in the group analysis. Fifteen volunteers (responders) reacted with an increase in PT during TVNS (p<0.01 vs. baseline) but not during the placebo session. Another six participants reported decreased PT during and after TVNS (p<0.05 vs. baseline), but not during the placebo session. Heart rate and blood pressure did not change during the study. Transcutaneous vagal nerve stimulation may produce both anti- and pro-nociceptive effects in healthy volunteers. The individual sensitivity and TVNS parameters might play a role.
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Affiliation(s)
- René Laqua
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine of Greifswald, Germany
| | - Bianca Leutzow
- Department of Anesthesiology, Intensive Care Medicine, University Medicine of Greifswald, Germany
| | - Michael Wendt
- Department of Anesthesiology, Intensive Care Medicine, University Medicine of Greifswald, Germany
| | - Taras Usichenko
- Department of Anesthesiology, Intensive Care Medicine, University Medicine of Greifswald, Germany.
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Demchenko IT, Gasier HG, Zhilyaev SY, Moskvin AN, Krivchenko AI, Piantadosi CA, Allen BW. Baroreceptor afferents modulate brain excitation and influence susceptibility to toxic effects of hyperbaric oxygen. J Appl Physiol (1985) 2014; 117:525-34. [PMID: 24994889 DOI: 10.1152/japplphysiol.00435.2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Unexplained adjustments in baroreflex sensitivity occur in conjunction with exposures to potentially toxic levels of hyperbaric oxygen. To investigate this, we monitored central nervous system, autonomic and cardiovascular responses in conscious and anesthetized rats exposed to hyperbaric oxygen at 5 and 6 atmospheres absolute, respectively. We observed two contrasting phases associated with time-dependent alterations in the functional state of the arterial baroreflex. The first phase, which conferred protection against potentially neurotoxic doses of oxygen, was concurrent with an increase in baroreflex sensitivity and included decreases in cerebral blood flow, heart rate, cardiac output, and sympathetic drive. The second phase was characterized by baroreflex impairment, cerebral hyperemia, spiking on the electroencephalogram, increased sympathetic drive, parasympatholysis, and pulmonary injury. Complete arterial baroreceptor deafferentation abolished the initial protective response, whereas electrical stimulation of intact arterial baroreceptor afferents prolonged it. We concluded that increased afferent traffic attributable to arterial baroreflex activation delays the development of excessive central excitation and seizures. Baroreflex inactivation or impairment removes this protection, and seizures may follow. Finally, electrical stimulation of intact baroreceptor afferents extends the normal delay in seizure development. These findings reveal that the autonomic nervous system is a powerful determinant of susceptibility to sympathetic hyperactivation and seizures in hyperbaric oxygen and the ensuing neurogenic pulmonary injury.
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Affiliation(s)
- Ivan T Demchenko
- Center for Hyperbaric Medicine and Environmental Physiology, and Departments of Anesthesiology and Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Heath G Gasier
- Center for Hyperbaric Medicine and Environmental Physiology, and Departments of Anesthesiology and
| | - Sergei Yu Zhilyaev
- Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexander N Moskvin
- Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexander I Krivchenko
- Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Claude A Piantadosi
- Center for Hyperbaric Medicine and Environmental Physiology, and Departments of Anesthesiology and Medicine, Duke University Medical Center, Durham, North Carolina
| | - Barry W Allen
- Center for Hyperbaric Medicine and Environmental Physiology, and Departments of Anesthesiology and
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Phelan E, Schneider R, Lorenz K, Dralle H, Kamani D, Potenza A, Sritharan N, Shin J, W. Randolph G. Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: A prospective, multicenter study. Laryngoscope 2014; 124:1498-505. [DOI: 10.1002/lary.24550] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Eimear Phelan
- Division of Thyroid and Parathyroid Surgery; Department of Laryngology and Otology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts
| | - Rick Schneider
- Division General-Visceral and Vascular Surgery; University of Halle-Wittenberg; Halle Germany
| | - Kerstin Lorenz
- Division of Surgical Oncology; Department of Surgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
| | - Henning Dralle
- Division General-Visceral and Vascular Surgery; University of Halle-Wittenberg; Halle Germany
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery; Department of Laryngology and Otology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts
| | - Andre Potenza
- Division of Thyroid and Parathyroid Surgery; Department of Laryngology and Otology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts
| | - Niranjan Sritharan
- Division of Thyroid and Parathyroid Surgery; Department of Laryngology and Otology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts
| | - Jenifer Shin
- Division of Thyroid and Parathyroid Surgery; Department of Laryngology and Otology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery; Department of Laryngology and Otology; Massachusetts Eye and Ear Infirmary; Harvard Medical School; Boston Massachusetts
- Division of Surgical Oncology; Department of Surgery; Massachusetts General Hospital; Harvard Medical School; Boston Massachusetts
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Dionigi G, Chiang FY, Dralle H, Boni L, Rausei S, Rovera F, Piantanida E, Mangano A, Barczyński M, Randolph GW, Dionigi R, Ulmer C. Safety of neural monitoring in thyroid surgery. Int J Surg 2013; 11 Suppl 1:S120-6. [DOI: 10.1016/s1743-9191(13)60031-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Leutzow B, Lange J, Gibb A, Schroeder H, Nowak A, Wendt M, Usichenko TI. Vagal sensory evoked potentials disappear under the neuromuscular block - an experimental study. Brain Stimul 2013; 6:812-6. [PMID: 23602023 DOI: 10.1016/j.brs.2013.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/25/2013] [Accepted: 03/09/2013] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Transcutaneous vagal nerve stimulation is a promising treatment modality in patients suffering mood disorders and chronic pain, however, the mechanisms are still to be elucidated. A recently developed technique of EEG responses to electrical stimulation of the inner side of the tragus suggests that these responses are far field potentials, generated in the vagal system - Vagal Sensory Evoked Potentials (VSEP). OBJECTIVE To reproduce the VSEP technique free from myogenic artifacts. METHODS Fourteen ASA I-II patients scheduled for elective surgery in standardized Total Intravenous Anesthesia (TIVA) were enrolled. Transcutaneous electrical stimulation was applied to the inner side of the right tragus. Averaged EEG responses were recorded from the electrode positions C4-F4 and T4-O2 before and after induction of TIVA, during the maximal effect of the non-depolarizing muscle relaxing agent, cis-atracurium (C-AR) and after recovery from C-AR under TIVA. RESULTS Typical response curves with P1, N1 and P2 peaks could be reproduced in all patients before and after anesthesia induction. The response curves disappeared during the C-AR action and re-appeared after recovery from C-AR under TIVA. CONCLUSION The disappearance of the scalp responses to electrical tragus stimulation under the neuromuscular block suggests a muscular origin of these potentials.
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Affiliation(s)
- Bianca Leutzow
- Department of Anesthesiology and Intensive Care Medicine, University Medicine of Greifswald, Germany
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Abstract
Blood pressure (BP) is one of the vital parameters used to assess the cardiovascular functions of a mammal. BP is commonly recorded using invasive, noninvasive, and radio telemetry methods, but invasive blood pressure (IBP) recording is considered the gold standard. IBP provides a direct indication of the effect of the investigational products on the circulatory system. Recording the IBP in rodents is an essential part of the preliminary screening of any product to determine its effect on the cardiovascular system. The present article describes the measurement of the IBP in Wistar rats/Sprague Dawley rats.
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Affiliation(s)
- Subramani Parasuraman
- Department of Pharmacology, Jawaharlal Institute of Postgradute Medical Education and Research, Pondicherry, India
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Melanocortins and the cholinergic anti-inflammatory pathway. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2012; 681:71-87. [PMID: 21222261 DOI: 10.1007/978-1-4419-6354-3_6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Experimental evidence indicates that small concentrations of inflammatory molecules produced by damaged tissues activate afferent signals through ascending vagus nerve fibers, that act as the sensory arm of an "inflammatory reflex". The subsequent activation of vagal efferent fibers, which represent the motor arm of the inflammatory reflex, rapidly leads to acetylcholine release in organs of the reticuloendothelial system. Acetylcholine interacts with α7 subunit-containing nicotinic receptors in tissue macrophages and other immune cells and rapidly inhibits the synthesis/release of tumor necrosis factor-α and other inflammatory cytokines. This neural anti-inflammatory response called "cholinergic anti-inflammatory pathway" is fast and integrated through the central nervous system. Preclinical studies are in progress, with the aim to develop therapeutic agents able to activate the cholinergic anti-inflammatory pathway. Melanocortin peptides bearing the adrenocorticotropin/α-melanocyte-stimulating hormone sequences exert a protective and life-saving effect in animals and humans in conditions of circulatory shock. These neuropeptides are likewise protective in other severe hypoxic conditions, such as prolonged respiratory arrest, myocardial ischemia, renal ischemia and ischemic stroke, as well as in experimental heart transplantation. Moreover, experimental evidence indicates that melanocortins reverse circulatory shock, prevent myocardial ischemia/reperfusion damage and exert neuroprotection against ischemic stroke through activation of the cholinergic anti-inflammatory pathway. This action occurs via stimulation of brain melanocortin MC3/MC4 receptors. Investigations that determine the molecular mechanisms of the cholinergic anti-inflammatory pathway activation could help design of superselective activators of this pathway.
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Abstract
Despite advances in antiepileptic medication therapy, a significant number of pediatric patients with epilepsy have seizures that are not well controlled. This article provides anesthesiologists with an overview of seizures in the pediatric population, including evaluation, medical treatment, surgical options, and the anesthetic implications of caring for this special population.
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Affiliation(s)
- Jeffrey L Koh
- Department of Anesthesiology and Perioperative Medicine, Doernbecher Children's Hospital/Oregon Health and Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97205, USA.
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Napadow V, Edwards RR, Cahalan CM, Mensing G, Greenbaum S, Valovska A, Li A, Kim J, Maeda Y, Park K, Wasan AD. Evoked pain analgesia in chronic pelvic pain patients using respiratory-gated auricular vagal afferent nerve stimulation. PAIN MEDICINE 2012; 13:777-89. [PMID: 22568773 DOI: 10.1111/j.1526-4637.2012.01385.x] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous vagus nerve stimulation (VNS) studies have demonstrated antinociceptive effects, and recent noninvasive approaches, termed transcutaneous-vagus nerve stimulation (t-VNS), have utilized stimulation of the auricular branch of the vagus nerve in the ear. The dorsal medullary vagal system operates in tune with respiration, and we propose that supplying vagal afferent stimulation gated to the exhalation phase of respiration can optimize t-VNS. DESIGN Counterbalanced, crossover study. PATIENTS Patients with chronic pelvic pain (CPP) due to endometriosis in a specialty pain clinic. INTERVENTIONS/OUTCOMES: We evaluated evoked pain analgesia for respiratory-gated auricular vagal afferent nerve stimulation (RAVANS) compared with nonvagal auricular stimulation (NVAS). RAVANS and NVAS were evaluated in separate sessions spaced at least 1 week apart. Outcome measures included deep-tissue pain intensity, temporal summation of pain, and anxiety ratings, which were assessed at baseline, during active stimulation, immediately following stimulation, and 15 minutes after stimulus cessation. RESULTS RAVANS demonstrated a trend for reduced evoked pain intensity and temporal summation of mechanical pain, and significantly reduced anxiety in N = 15 CPP patients, compared with NVAS, with moderate to large effect sizes (η(2) > 0.2). CONCLUSION Chronic pain disorders such as CPP are in great need of effective, nonpharmacological options for treatment. RAVANS produced promising antinociceptive effects for quantitative sensory testing (QST) outcomes reflective of the noted hyperalgesia and central sensitization in this patient population. Future studies should evaluate longer-term application of RAVANS to examine its effects on both QST outcomes and clinical pain.
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Affiliation(s)
- Vitaly Napadow
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA, USA.
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Kubiski R. Perioperative care of the child with epilepsy. AORN J 2012; 95:635-44; quiz 645-7. [PMID: 22541774 DOI: 10.1016/j.aorn.2012.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 02/17/2012] [Indexed: 10/28/2022]
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Aron M, Vlachos-Mayer H, Dorion D. Vocal cord adduction causing obstructive sleep apnea from vagal nerve stimulation: case report. J Pediatr 2012; 160:868-70. [PMID: 22364850 DOI: 10.1016/j.jpeds.2012.01.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 11/28/2011] [Accepted: 01/24/2012] [Indexed: 10/28/2022]
Abstract
A recognized complication of vagal nerve stimulation is new or worsening sleep apnea. Its pathophysiology is not clearly understood. We report a patient with obstructive sleep apnea that was directly associated with vagal nerve stimulation causing recurring vocal cord adduction. Adjusting the stimulator settings resolved the problem.
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Affiliation(s)
- Margaret Aron
- Department of Otolaryngology Head and Neck Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada.
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