• International journal of advanced smart convergence
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• 제9권3호
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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.

• 대한후두음성언어의학회지
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• 제26권1호
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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.

• International journal of advanced smart convergence
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• 제9권4호
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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.

• International journal of advanced smart convergence
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• 제9권1호
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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.

• Annals of Clinical Neurophysiology
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• 제10권1호
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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.

• 대한두경부종양학회지
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• 제36권1호
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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.

• International journal of thyroidology
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• 제11권2호
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• pp.109-116
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• 2018

갑상선 수술 후 발생한 성대마비는 삶의 질을 중요시하는 요즘 시대에 제일 치명적 합병증 중 하나이다. 그 결과 수술 중 신경감시시스템의 사용은 보편화되고 있으나 아직 기존의 시스템은 외과 의사가 사용하기에 불편하거나 문제점들이 있다. 그래서 새로운 방식의 신경 탐침과 신경 감시 장치의 개발이 필요한 시점이다. 이에 최근 모든 수술 기구(금속형 기구, 내시경 및 로봇 기구, 에너지 기반 디바이스)에 탈부착이 가능한 신경을 자극하는 신경 탐침 및 후두 떨림을 측정하기 위한 표면압력센서를 이용한 새로운 형태의 수술 중 신경감시시스템의 개발에 대한 연구가 기대된다.

• 임상이비인후과
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• 제29권2호
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• pp.162-166
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• 2018

• 임상이비인후과
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• 제29권2호
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• pp.173-176
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• 2018

• 임상이비인후과
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• 제29권2호
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• pp.177-181
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• 2018