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A Study on The Relationship Between Intraoperative Neuromonitoring and Hemoglobin Changes

  • Lee, Kyuhyun (Department of Health Sciences, Dankook University) ;
  • Kim, Jaekyung (Department of Health Sciences, Dankook University)
  • Received : 2020.08.28
  • Accepted : 2020.09.10
  • Published : 2020.12.31

Abstract

This study was conducted in order to determine the effect of intraoperative hemoglobin changes on intraoperative neuromonitoring (IONM). This was a retrospective study that included 339 participants who underwent cerebrovascular surgery. We compared anesthetic agents, intraoperative hemoglobin, hematocrit, blood transfusion, and blood loss. We examined motor evoked potential and sensory evoked potential to patients. There were significant differences in hemoglobin changes, bleeding levels, transfusion, anesthesia time, and postoperative mobility disorders. Moreover, compared with patients who received transfusions, those who did not receive transfusion had a lower average hemoglobin level, as well as a higher bleeding amount, and a need of higher anesthesia time and anesthetic dose. Also, we found vasospasm occurred while surgery can bring adverse results after operation. This study showed that an intraoperative decrease in hemoglobin levels affects the function of cerebral perfusion, which could result in abnormal nerve monitoring results. However, as this study could not find a relation of anesthetics to IONM, there is a need for further research regarding the association between anesthetics and hemoglobin changes and IONM.

Keywords

References

  1. A. Gruber et al., "Prospective Comparison of Intraoperative Vascular Monitoring Technologies During Cerebral Aneurysm Surgery," Neurosurgery, Vol. 68, No. 3, pp. 657-673, 2011. DOI: https://doi.org/10.1227/neu.0b013e31820777ee
  2. P. Stankovic et al., "Continuous Intraoperative Neuromonitoring (Cionm) in Head and Neck Surgery-a Review," HNO. pp. 1-7, 2020. DOI: https://doi.org/10.1007/s00106-020-00824-1
  3. D. Macdonald, S. Skinner, J. Shils, and C. Yingling, "Intraoperative Motor Evoked Potential Monitoring-a Position Statement by the American Society of Neurophysiological Monitoring," Clinical Neurophysiology, Vol. 124, No. 12, pp. 2291-2316, 2013. DOI: https://doi.org/10.1016/j.clinph.2013.07.025
  4. Y. Morimoto, M. Mathru, J.F. Martinez-Tica, and M.H. Zornow, "Effects of Profound Anemia on Brain Tissue Oxygen Tension, Carbon Dioxide Tension, and Ph in Rabbits," Journal of Neurosurgical Anesthesiology, Vol.13, No.1, pp. 33-39, 2011. DOI: https://doi.org/10.1097/00008506-200101000-00006
  5. L. Van De Watering, J. Lorinser, M. Versteegh, R. Westendord, and A. Brand, "Effects of Storage Time of Red Blood Cell Transfusions on the Prognosis of Coronary Artery Bypass Graft Patients," Transfusion, Vol. 46, No. 10, pp. 1712-1718, 2006. DOI: https://doi.org/10.1111/j.1537-2995.2006.00958.x
  6. A. Brand, "Immunological Aspects of Blood Transfusions," Transplant immunology, Vol. 10, No. 2-3, pp. 183-190, 2002. DOI: https://doi.org/10.1016/s0966-3274(02)00064-3
  7. T. Inagawa, "Risk Factors for Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage: A Review of the Literature," World Neurosurgery, Vol. 85, pp. 56-76, 2016. DOI: https://doi.org/10.1016/j.wneu.2015.08.052
  8. I. Maran, A. Gadani, and I. Silverman, "Fourteen-Day Delay of Cerebral Ischemia Due to Vasospasm after Traumatic Subarachnoid Hemorrhage in Mild Head Injury," Neurology Vol. 92, No. 15, pp. 1-3, 2019. https://doi.org/10.1212/WNL.0000000000006677
  9. M. Oddo et al., "Hemoglobin Concentration and Cerebral Metabolism in Patients with Aneurysmal Subarachnoid Hemorrhage," Stroke, Vol. 40, No. 4, pp. 1275-1281, 2009. DOI: https://doi.org/10.1161/strokeaha.108.527911
  10. L. de la Maza Krzeptowsky, "Clinical Practice Guidelines (CPG) to Intraoperative Neurophysiological Monitoring (IONM)," Clinical Neurophysiology, Vol. 127, No. 9, pp. e312, 2016. DOI: https://doi.org/10.1016/j.clinph.2016.05.316
  11. R. W. Bohannon, "Considerations and Practical Options for Measuring Muscle Strength: A Narrative Review," BioMed Research International, 2019. DOI: https://doi.org/10.1155/2019/8194537
  12. M. J. Kim and G. Y. Kang, "The Convergence Study on the Relationship between the Job Stress and Mental Health of Nurses," Journal of the Korea Convergence Society, Vol. 6 No. 5, pp. 39-47, 2015. DOI: https://doi.org/10.15207/jkcs.2015.6.5.039
  13. S. E. Park et al., "Decreased Hemoglobin Levels, Cerebral Small-Vessel Disease, and Cortical Atrophy: Among Cognitively Normal Elderly Women and Men," International Psychogeriatrics, Vol. 28, No. 1, pp. 147-156, 2016. DOI: https://doi.org/10.1017/s1041610215000733
  14. D. Guo et al., "Propofol Post-Conditioning after Temporary Clipping Reverses Oxidative Stress in Aneurysm Surgery," International Journal of Neuroscience, Vol. 129, No. 2, pp. 157-166, 2019. https://doi.org/10.1080/00207454.2018.1483920
  15. R. Dhar et al., "Red Blood Cell Transfusion Increases Cerebral Oxygen Delivery in Anemic Patients with Subarachnoid Hemorrhage," Stroke, Vol. 40, No.9, pp. 3039-3044, 2009. DOI: https://doi.org/10.1161/strokeaha.109.556159
  16. M. Munoz et al., "Pre-Operative Haemoglobin Levels and Iron Status in a Large Multicentre Cohort of Patients Undergoing Major Elective Surgery," Anaesthesia, Vol. 72, No. 7, pp. 826-834, 2017. https://doi.org/10.1111/anae.13840
  17. T. Luostarinen et al., "Transfusion Frequency of Red Blood Cells, Fresh Frozen Plasma, and Platelets During Ruptured Cerebral Aneurysm Surgery," World Neurosurgery, Vol. 84, No. 2, pp. 446-450, 2015. DOI: https://doi.org/10.1016/j.wneu.2015.03.053
  18. M. E. Steiner et al., "Addressing the Question of the Effect of Rbc Storage on Clinical Outcomes: The Red Cell Storage Duration Study (Recess)(Section 7)," Transfusion and Apheresis Science, Vol. 43, No. 1, pp. 107-116, 2010. DOI: https://doi.org/10.1016/j.transci.2010.05.014
  19. A. Ekelund et al., "Effects of Iso-and Hypervolemic Hemodilution on Regional Cerebral Blood Flow and Oxygen Delivery for Patients with Vasospasm after Aneurysmal Subarachnoid Hemorrhage," Acta Neurochirurgica, Vol. 144, No. 7, pp. 703-713, 2003. DOI: https://doi.org/10.1007/s00701-002-0959-9
  20. V. Deletis, and J. Shils, "Neurophysiology in Neurosurgery: A Modern Intraoperative Approach," Elsevier, 2002.
  21. I. Ingelmo et al., "Intraoperative Monitoring of the Facial Nerve: Anesthesia and Neurophysiology Considerations," Revista Espanola de Anestesiologia y Reanimacion, Vol. 50, No. 9, pp. 460-471, 2003.
  22. R. Helbok et al., "Early Brain Injury after Aneurysmal Subarachnoid Hemorrhage: A Multimodal Neuromonitoring Study," Critical care, Vol. 19, No. 1, pp. 75, 2015. DOI: https://doi.org/10.1186/s13054-015-0809-9
  23. D. G. Choi and J. W. Jang, "A Study on the Development of a Program to Body Circulation Measurement Using the Machine Learning and Depth Camera," International Journal of Internet, Broadcasting and Communication, Vol.12, No. 1, pp. 122-129, 2020. DOI: https://doi.org/10.7236/IJIBC.2020.12.1.122
  24. K. H. Kim, B. K. Kim and H. J. Jeong, "Effect of Functional Pressure Garments on EMG Response of the Agonist during the Resistance Exercise of the Wrist and Elbow Joint," International Journal of Internet, Broadcasting and Communication, Vol. 12, No. 1, pp. 81-89, 2020. DOI: https://doi.org/10.7236/IJIBC.2020.12.1.81