Purpose Of Review: We will explain the basic principles of intraoperative neurophysiological monitoring (IONM) during spinal surgery. Thereafter we highlight the significant impact that general anesthesia can have on the efficacy of the IONM and provide an overview of the essential pharmacological and physiological factors that need to be optimized to enable IONM. Lastly, we stress the importance of teamwork between the anesthesiologist, the neurophysiologist, and the surgeon to improve clinical outcome after spinal surgery.
Recent Findings: In recent years, the use of IONM has increased significantly. It has developed into a mature discipline, enabling neurosurgical procedures of ever-increasing complexity. It is thus of growing importance for the anesthesiologist to appreciate the interplay between IONM and anesthesia and to build up experience working in a team with the neurosurgeon and the neurophysiologist.
Summary: Safety measures, cooperation, careful choice of drugs, titration of drugs, and maintenance of physiological homeostasis are essential for effective IONM.
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http://dx.doi.org/10.1097/ACO.0000000000001044 | DOI Listing |
Sci Rep
December 2024
Department of Neurosurgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, No.1678, Dongfang Road, Pudong District, Shanghai, China.
This study investigated the prevalence and severity of lower urinary tract symptoms (LUTS) in children with spastic cerebral palsy (SCP) and evaluated the effect of selective dorsal rhizotomy (SDR) in alleviating these symptoms. The study also explored the correlation between postoperative LUTS improvement and intraoperative electrophysiological findings. Prospective data were collected from a consecutive cohort of 247 children with SCP who underwent SDR and were retrospectively analyzed.
View Article and Find Full Text PDFCureus
November 2024
Anesthesiology and Pain Medicine, Harborview Medical Center, Seattle, USA.
Prompt emergence from general anesthesia is crucial after neurosurgical procedures, such as craniotomies, to facilitate timely neurological evaluation for identification of intraoperative complications. Delayed emergence can be caused by residual anesthetics, metabolic imbalances, and intracranial pathology, for which an eye examination can provide early diagnostic clues. The sunset sign (or setting sun sign), characterized by a downward deviation of the eyes, can be an early indicator of raised intracranial pressure (ICP) or midbrain compression, as is commonly observed in states of hydrocephalus or periaqueductal or tectal plate dysfunction.
View Article and Find Full Text PDFAnn Ital Chir
December 2024
Department of Anesthesiology & Key Laboratory of Clinical Science and Research, Zhongda Hospital, Southeast University, 210009 Nanjing, Jiangsu, China.
Aim: Postoperative delirium (POD) is a common complication with significant adverse effects in elderly patients. Electroencephalography (EEG) provides a promising approach for predicting the risk of POD. This study aims to elucidate the correlation between intraoperative EEG spectrum and the incidence of POD in elderly patients undergoing orthopedic surgery.
View Article and Find Full Text PDFWorld J Gastroenterol
December 2024
Department of Surgery and Centre of Minimal Invasive Surgery, GFO Kliniken Bonn, Bonn 53225, North Rhine-Westphalia, Germany.
This manuscript focused on the surgical challenge of urinary and sexual dysfunction after rectal cancer surgery based on the interesting results demonstrated by the observational study of Chen , which was published in the . Urinary dysfunction occurs in one-third of patients treated for rectal cancer. Surgical nerve damage is the main cause of urinary dysfunction.
View Article and Find Full Text PDFNeuroimage
December 2024
Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine and Health, 81675 Munich, Germany.
Background: Cortical high-frequency activation immediately before death has been reported, raising questions about an enhanced conscious state at this critical time. Here, we analyzed an electroencephalogram (EEG) from a comatose patient during the dying process with a standard bedside monitor and spectral parameterization techniques.
Methods: We report neurophysiologic features of a dying patient without major cortical injury.
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