Electrophysiological Monitoring of the Interactions Between the Serotonin and Dopamine Systems During Goal Directed Behaviors

2006 ◽  
Author(s):  
Zachary F. Mainen
Keyword(s):  
Electrophysiological Monitoring

scholarly journals Awareness during anaesthesia for surgery requiring evoked potential monitoring: A pilot study

2017 ◽  
Vol 04 (01) ◽  
pp. 036-041
Author(s):  
Pritish Korula ◽  
Ramamani Mariappan ◽  
Justin James ◽  
Prashant Kumar ◽  
Grace Korula
Keyword(s):  
Pilot Study ◽  
Evoked Potential ◽  
Motor Evoked Potential ◽  
Maintenance Phase ◽  
Primary Objective ◽  
Anaesthetic Technique ◽  
Depth Of Anaesthesia ◽  
Electrophysiological Monitoring ◽  
Evoked Potential Monitoring ◽  
Potential Monitoring

Abstract Background: Evoked potential monitoring such as somatosensory-evoked potential (SSEP) or motor-evoked potential (MEP) monitoring during surgical procedures in proximity to the spinal cord requires minimising the minimum alveolar concentrations (MACs) below the anaesthetic concentrations normally required (1 MAC) to prevent interference in amplitude and latency of evoked potentials. This could result in awareness. Our primary objective was to determine the incidence of awareness while administering low MAC inhalational anaesthetics for these unique procedures. The secondary objective was to assess the adequacy of our anaesthetic technique from neurophysiologist’s perspective. Methods: In this prospective observational pilot study, 61 American Society of Anesthesiologists 1 and 2 patients undergoing spinal surgery for whom intraoperative evoked potential monitoring was performed were included; during the maintenance phase, 0.7–0.8 MAC of isoflurane was targeted. We evaluated the intraoperative depth of anaesthesia using a bispectral (BIS) index monitor as well as the patients response to surgical stimulus (PRST) scoring system. Post-operatively, a modified Bruce questionnaire was used to verify awareness. The adequacy of evoked potential readings was also assessed. Results: Of the 61 patients, no patient had explicit awareness. Intraoperatively, 19 of 61 patients had a BIS value of above sixty at least once, during surgery. There was no correlation with PRST scoring and BIS during surgery. Fifty-four out of 61 patient’s evoked potential readings were deemed ‘good’ or ‘fair’ for the conduct of electrophysiological monitoring. Conclusions: This pilot study demonstrates that administering low MAC inhalational anaesthetics to facilitate evoked potential monitoring does not result in explicit awareness. However, larger studies are needed to verify this. The conduct of SSEP electrophysiological monitoring was satisfactory with the use of this anaesthetic technique. However, the conduct of MEP monitoring was satisfactory, only in patients with Nurick Grade 1 and 2. The MEP response was poor in patients with Nurick Grade 4 and 5.

Surgical excision of extensive sacrococcygeal chordomas assisted by occlusion of the abdominal aorta

2010 ◽  
Vol 12 (5) ◽  
pp. 490-496 ◽  
Author(s):  
Liu Xue-Song ◽  
You Chao ◽  
Yang Kai-Yong ◽  
Huang Si-Qing ◽  
Zhang Heng
Keyword(s):  
Abdominal Aorta ◽  
Postoperative Radiotherapy ◽  
Balloon Dilation ◽  
Surgical Excision ◽  
Neurological Dysfunction ◽  
Pelvic Cavity ◽  
Large Tumor ◽  
Electrophysiological Monitoring ◽  
Complex Anatomy

Object An extensive sacrococcygeal chordoma is considered a challenge for neurosurgeons. Because of the complex anatomy of the sacral region, the risk of uncontrollable intraoperative hemorrhage, and the typically large tumor size at presentation, complete resections are technically difficult and the tumor recurrence rate is high. The aim of this study was to assess the value of using occlusion of the abdominal aorta by means of a balloon dilation catheter and electrophysiological monitoring when an extensive sacrococcygeal chordoma is removed. Methods Between 2004 and 2008, 9 patients underwent resection of extensive sacrococcygeal chordomas in the authors' department with the aid of occlusion of the abdominal aorta and electrophysiological monitoring. All of these operations were performed via the posterior approach. The records of the 9 patients were reviewed retrospectively. Results Wide resections were performed in 6 cases and marginal excisions in the other 3. Five patients underwent postoperative radiotherapy. Intraoperative hemorrhage was controlled at 100–400 ml. Postoperatively, none of the patients had any new neurological dysfunction, and 2 patients regained normal urinary and bowel function. The mean follow-up period was 31.4 months (range 10–57 months). No patient developed local recurrence or had metastatic spread of tumor during follow-up. Conclusions Occlusion of the abdominal aorta and electrophysiological monitoring are useful methods for assisting in resection of sacrococcygeal chordoma. They can reduce intraoperative hemorrhage and entail little chance of tumor cell contamination. They can also help surgeons to protect the organs in the pelvic cavity and neurological function. Use of these methods could give patients better quality of life.

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