• Title, Summary, Keyword: Intraoperative neuromonitoring

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Effects of changes in blood pressure during brain vascular surgery on intraoperative neuromonitoring

  • Lee, Kyuhyun;Kim, Jaekyung
    • International journal of advanced smart convergence
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    • v.9 no.3
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    • pp.71-77
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    • 2020
  • This study was conducted in order to determine how reductions in blood pressure during surgery affect intraoperative neuromonitoring. This retrospective study considered a total of 339 patients: 194 patients with normal neuromonitoring findings (57%), 145 (42%) with abnormal neuromonitoring findings, and 34 (10%) with postoperative neurological deficits. Comparisons between the three groups revealed that overall blood pressure during surgery, postoperative blood pressure, and the difference between the maximum and minimum blood pressure could affect the intraoperative neuromonitoring findings. While we indicate that a drop in blood pressure to below 70 mmHg could affect neuromonitoring results, differences in the dosage of anesthetic agents did not significantly affect reductions in blood pressure or neuromonitoring findings. The association of monitoring with blood pressure found in this study is expected to help future examiners. However, this study did not clarify the relationship between anesthesia and blood pressure and how it could affect intraoperative neuromonitoring. Therefore, further research on this part is thought to be necessary.

Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve and Superior Laryngeal Nerve (되돌이후두신경과 상후두신경의 수술중 신경감시)

  • Hah, J. Hun;Jin, Young Ju
    • Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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    • v.26 no.1
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    • pp.13-15
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    • 2015
  • Intraoperative neuromonitoring of thyroid surgery has gained universal validity to help in nerve identification, safe nerve dissection, and prediction of postoperative vocal cord function. In this article, standard intraoperative neuromonitoring procedure, interpretation about loss of signal, and the indications covered by health insurance will be described.

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A Study on The Relationship Between Intraoperative Neuromonitoring and Hemoglobin Changes

  • Lee, Kyuhyun;Kim, Jaekyung
    • International journal of advanced smart convergence
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    • v.9 no.4
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    • pp.8-15
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    • 2020
  • 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.

Motor and Somato Sensory Evoked Potentials During Intraoperative Surveillance Testing in Patients with Diabetes

  • Lee, Kyuhyun;Kim, Jaekyung
    • International journal of advanced smart convergence
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    • v.9 no.1
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    • pp.37-46
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    • 2020
  • Cerebral vascular surgery can damage patients' motor and sensory nerves; therefore, neuromonitoring is performed intraoperatively. Patients with diabetes often have peripheral neuropathy and may be prone to nerve damage during surgery. This study aimed to identify factors that should be considered when diabetic patients undergo intraoperative neuromonitoring during brain vascular surgery and to present new criteria. Methods: In patients with and without diabetes who underwent cerebrovascular surgery (n = 30/group), we compared the intraoperative stimulation intensity, postoperative motor power and sensory, glycated hemoglobin (HbA1c) and glucose levels, and imaging findings. Results: Fasting glucose, blood glucose, and HbA1c levels were 10%, 12.1%, and 9.7%, respectively; they were higher in patients with than in patients without diabetes. Two patients with diabetes had weakness, and 10 required increased Somato sensory evoked potential (SSEP) stimulation, while in 16, motor power recovered over time rather than immediately. The non-diabetic group had no weakness after surgery, but 10 patients required more increased SSEP stimulation. The diabetic group showed significantly more abnormal test results than the non-diabetic group. Conclusion: For patients with diabetes undergoing surgery with intraoperative neuromonitoring, whether diabetic peripheral neuropathy is present, their blood glucose level and the anesthetic used should be considered.

Intraoperative Neuromonitoring (수술 중 신경계 감시)

  • Seo, Dae-Won
    • Annals of Clinical Neurophysiology
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    • v.10 no.1
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    • pp.1-12
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    • 2008
  • Intraoperative neuromonitoring (INM) is well known to be useful method to reduce intraoperative complications during the surgery of nervous system lesions. Evoked potentials are most commonly used among the electrophysiological tests. Brainstem auditory evoked potentials are for detecting the problems along the auditory pathways including the eighth cranial nerve and brainstem. Somatosensory evoked potentials are applied for preventing the spinal cord lesions. The INM is affected by many factors. In order to perform an optimal INM, the confounding factors including technical, anesthetical, and individual factors should be kept well under control. INM has frequent electrophysiologic changes during the surgery and it might be helpful to keep one's eyes on which monitoring modalities are reluctant to change during each operation. The skillful monitoring and timely interpretation of electrophysiologic changes can drive the patient to be undergone surgery, even in high surgical risk group.

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Effectiveness of Intraoperative Neuromonitoring According to the Mechanism of Recurrent Laryngeal Nerve Injury During Thyroid Surgery (갑상선 수술 중 반회후두신경의 손상 기전에 따른 신경 감시술의 효용성)

  • Shin, Sung-Chan;Lee, Byung-Joo
    • Korean Journal of Head & Neck Oncology
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    • v.36 no.1
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    • pp.9-14
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    • 2020
  • Visual identification of recurrent laryngeal nerve (RLN) is considered as a gold standard of RLN preservation during thyroid surgery. Intraoperative neuromonitoring (IONM) is classified into the intermittent type and continuous type and helps surgeons identify the functional integrity of RLN and predict the postoperative vocal cord function. RLN injury during thyroid surgery is associated with tumor factors and surgeon factors. Tumor factors mean such as direct tumor invasion, adhesion of RLN to the tumor, and compression by a large thyroid tumor. Surgeon factors include nerve transection, stretching, thermal injury, and ligation injury. A recent meta-analysis reported that the IONM could reduce the RLN injury. Considering various nerve injury mechanism, we suggest that using both I-ONM and C-IONM together is more effective method in preventing nerve damage than using I-IONM alone.

Development of the Novel Intraoperative Neuromonitoring for Thyroid Surgery (갑상선 수술을 위한 새로운 수술 중 신경감시시스템의 개발)

  • Sung, Eui Suk;Lee, Byung Joo
    • International journal of thyroidology
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    • v.11 no.2
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    • pp.109-116
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    • 2018
  • It is very important to identify recurrent laryngeal nerve (RLN) and prevent RLN injury during thyroid surgery. The intraoperative neuromonitoring (IONM) for the prevention of RLN injury is a useful method because it can identify the location and status of RLN and predict postoperative vocal cord function easily. The IONM consists of a stimulating side that applies electrical stimulation to the nerve and a recording side that measures the surface electromyography (EMG) of the vocal cord muscle through electrode endotracheal tube. The nerve stimulator and surgical dissector are separate instruments. So, during IONM for the prevention of the RLN injury in conventional, endoscopic, or robotic thyroid surgery, repeated exchanging between surgical instruments and the nerve stimulator is inconvenient and time consuming. On the recording side, the accuracy of the electrode endotracheal tube which measures the EMG of the vocalis muscle can be affected by contact with between electrode and vocal fold and position change of patient. We would like to introduce recent several researches to overcome the current limitations of IONM.