1
|
Electrophysiologic Monitoring in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
2
|
Somatosensory and transcranial motor evoked potential monitoring in a porcine model for experimental procedures. PLoS One 2018; 13:e0205410. [PMID: 30296297 PMCID: PMC6175523 DOI: 10.1371/journal.pone.0205410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/25/2018] [Indexed: 11/19/2022] Open
Abstract
Evoked potential monitoring has evolved as an essential tool not only for elaborate neurological diagnostics, but also for general clinical practice. Moreover, it is increasingly used to guide surgical procedures and prognosticate neurological outcome in the critical care unit, e.g. after cardiac arrest. Experimental animal models aim to simulate a human-like scenario to deduct relevant clinical information for patient treatment and to test novel therapeutic opportunities. Porcine models are particularly ideal due to a comparable cardiovascular system and size. However, certain anatomic disparities have to be taken into consideration when evoked potential monitoring is used in animal models. We describe a non-invasive and reproducible set-up useful for different modalities in porcine models. We further illustrate hints to overcome multi-faceted problems commonly occurring while using this sophisticated technique. Our descriptions can be used to answer a plethora of experimental questions, and help to further facilitate experimental therapeutic innovation.
Collapse
|
3
|
André-Obadia N, Zyss J, Gavaret M, Lefaucheur JP, Azabou E, Boulogne S, Guérit JM, McGonigal A, Merle P, Mutschler V, Naccache L, Sabourdy C, Trébuchon A, Tyvaert L, Vercueil L, Rohaut B, Delval A. Recommendations for the use of electroencephalography and evoked potentials in comatose patients. Neurophysiol Clin 2018; 48:143-169. [DOI: 10.1016/j.neucli.2018.05.038] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
|
4
|
Neurophysiological assessment of brain dysfunction in critically ill patients: an update. Neurol Sci 2017; 38:715-726. [PMID: 28110410 DOI: 10.1007/s10072-017-2824-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 01/16/2017] [Indexed: 01/08/2023]
Abstract
The aim of this review was to provide up-to-date information about the usefulness of clinical neurophysiology testing in the management of critically ill patients. Evoked potentials (EPs) and electroencephalogram (EEG) are non-invasive clinical neurophysiology tools that allow an objective assessment of the central nervous system's function at the bedside in intensive care unit (ICU). These tests are quite useful in diagnosing cerebral complications, and establishing the vital and functional prognosis in ICU. EEG keeps a particularly privileged importance in detecting seizures phenomena such as subclinical seizures and non-convulsive status epilepticus. Quantitative EEG (QEEG) analysis techniques commonly called EEG Brain mapping can provide obvious topographic displays of digital EEG signals characteristics, showing the potential distribution over the entire scalp including filtering, frequency, and amplitude analysis and color mapping. Evidences of usefulness of QEEG for seizures detection in ICU are provided by several recent studies. Furthermore, beyond detection of epileptic phenomena, changes of some QEEG panels are early warning indicators of sedation level as well as brain damage or dysfunction in ICU. EPs offer the opportunity for assessing brainstem's functional integrity, as well as subcortical and cortical brain areas. A multimodal use, combining EEG and various modalities of EPs is recommended since this allows a more accurate functional exploration of the brain and helps caregivers to tailor therapeutic measures according to neurological worsening trends and to anticipate the prognosis in ICU.
Collapse
|
5
|
Sato A. Interpretation of the causes of instability of flash visual evoked potentials in intraoperative monitoring and proposal of a recording method for reliable functional monitoring of visual evoked potentials using a light-emitting device. J Neurosurg 2016; 125:888-897. [PMID: 26894463 DOI: 10.3171/2015.10.jns151228] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Effective monitoring and application of visual evoked potentials (VEPs) during neurosurgery is a major challenge. While many monitoring methods have been effectively used, the use of VEPs as an objective determination method has not been established. The purpose of this report was to present a method for overcoming this limitation according to the use of a specific stimulus. METHODS Data analysis was performed in 26 cases of brain surgery. Observation was carried out for 2 groups of responses: the response derived from the start of light emission, described as the on response, and the response derived from the end of light emission, described as the off response. These reactions were separated by extending the light emission time. The waves from the visual cortex were selected from each reaction following the start and the end of light emission with consideration for the characteristics of the potential distribution. The waves were observed to characterize changes resulting from variations in duration and quantity of light emission. The results of the analysis were used to determine the optimal emission time and amount of light for effective use of wave components during VEP monitoring. RESULTS Stable and recordable waves were observed by monitoring the off response, consisting of the P1-N1-P2 component, with a wave latency of approximately 100 msec. Since the off response was correlated with the input, the stable wave derived from the off response could be adjusted by changing the light emission time and intensity. Individual differences in the latency of the off response were decreased by extending the light emission time and reducing the quantity of light. However, it was difficult to achieve stability by adjusting the light intensity and emission time using the on response. The off response was confirmed to be sufficiently stable for intraoperative monitoring. Moreover, during 1 case in which manipulation of the optic nerve was necessary, reduction in the off response was found to occur when the nerve was manipulated and to reverse when the manipulation stopped. CONCLUSIONS The off response was shown to have the capacity to function as a monitoring tool, providing more stable wave forms than the on response. Recording conditions could be adjusted to achieve a light-emitting time of 500 msec and a light quantity of 8000 Lx. Stable monitoring of VEPs using light-emitting stimuli can contribute toward improving surgical outcomes.
Collapse
Affiliation(s)
- Atsushi Sato
- Division of Neurosurgery, Ina Central Hospital, Ina, Japan
| |
Collapse
|
6
|
Jin SH, Chung CK, Kim JE, Choi YD. A new measure for monitoring intraoperative somatosensory evoked potentials. J Korean Neurosurg Soc 2014; 56:455-62. [PMID: 25628803 PMCID: PMC4303719 DOI: 10.3340/jkns.2014.56.6.455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/27/2022] Open
Abstract
Objective To propose a new measure for effective monitoring of intraoperative somatosensory evoked potentials (SEP) and to validate the feasibility of this measure for evoked potentials (EP) and single trials with a retrospective data analysis study. Methods The proposed new measure (hereafter, a slope-measure) was defined as the relative slope of the amplitude and latency at each EP peak compared to the baseline value, which is sensitive to the change in the amplitude and latency simultaneously. We used the slope-measure for EP and single trials and compared the significant change detection time with that of the conventional peak-to-peak method. When applied to single trials, each single trial signal was processed with optimal filters before using the slope-measure. In this retrospective data analysis, 7 patients who underwent cerebral aneurysm clipping surgery for unruptured aneurysm middle cerebral artery (MCA) bifurcation were included. Results We found that this simple slope-measure has a detection time that is as early or earlier than that of the conventional method; furthermore, using the slope-measure in optimally filtered single trials provides warning signs earlier than that of the conventional method during MCA clipping surgery. Conclusion Our results have confirmed the feasibility of the slope-measure for intraoperative SEP monitoring. This is a novel study that provides a useful measure for either EP or single trials in intraoperative SEP monitoring.
Collapse
Affiliation(s)
- Seung-Hyun Jin
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. ; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. ; Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. ; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea. ; Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
| | - Young Doo Choi
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
7
|
Effect of mild hypothermic cardiopulmonary bypass on the amplitude of somatosensory-evoked potentials. J Neurosurg Anesthesiol 2014; 26:161-6. [PMID: 24492514 DOI: 10.1097/ana.0000000000000016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several neurophysiological techniques are used to intraoperatively assess cerebral functioning during surgery and intensive care, but the introduction of hypothermia as a means of intraoperative neuroprotection has brought their reliability into question. The present study aimed to evaluate the effect of mild hypothermia on somatosensory-evoked potentials' (SSEPs) amplitude and latency in a cohort of cardiopulmonary bypass (CPB) patients as the temperature reached the steady-state. MATERIALS AND METHODS The amplitude and latency of 4 different SSEP signals--N9, N13, P14/N18 interpeak, and N20/P25--were evaluated retrospectively in 84 patients undergoing CPB during normothermic (36°C±0.43°C) and mild hypothermic (32°C±1.38°C) conditions. SSEPs were recorded in normothermia immediately after the induction of anesthesia and in hypothermia as the temperature reached its steady-state, specifically, when the nasopharyngeal temperature was equivalent to the rectal temperature (±0.5°C). A paired-samples t test was performed for each SSEP to test the differences in latencies and amplitudes between normothermic and hypothermic conditions. RESULTS Compared with normothermia, hypothermia not only significantly increased the latency of all SSEPs, N9 (P<0.001), N13 (P<0.001), P14/N18 (P<0.001), and N20/P25 (P<0.001), but also the amplitude of N9 (P<0.001) and N20/P25 (P<0.001). CONCLUSIONS The increased amplitude in particularly of cortical SSEPs (N20/P25), detected specifically during steady-state hypothermia, seems to support the clinical utility of this methodology in monitoring the brain function not only during cardiac surgery with CPB, but also in other settings like therapeutic hypothermia procedures in an intensive care unit.
Collapse
|
8
|
Soghomonyan S, Moran KR, Sandhu GS, Bergese SD. Anesthesia and evoked responses in neurosurgery. Front Pharmacol 2014; 5:74. [PMID: 24782777 PMCID: PMC3995060 DOI: 10.3389/fphar.2014.00074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/28/2014] [Indexed: 11/24/2022] Open
Affiliation(s)
- Suren Soghomonyan
- Department of Anesthesiology, Wexner Medical Center, Ohio State University Columbus, OH, USA
| | - Kenneth R Moran
- Department of Anesthesiology, Wexner Medical Center, Ohio State University Columbus, OH, USA
| | - Gurneet S Sandhu
- Department of Anesthesiology, Wexner Medical Center, Ohio State University Columbus, OH, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Wexner Medical Center, Ohio State University Columbus, OH, USA ; Department of Neurological Surgery, Wexner Medical Center, Ohio State University Columbus, OH, USA
| |
Collapse
|
9
|
The changes of brainstem auditory evoked potentials (BAEP) after vertebrobasilar artery ischemia in rabbits. Neurol Sci 2012; 33:1155-60. [DOI: 10.1007/s10072-012-0930-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 01/02/2012] [Indexed: 10/14/2022]
|
10
|
Obligatory cortical auditory evoked potential waveform detection and differentiation using a commercially available clinical system: HEARLab™. Ear Hear 2012; 32:782-6. [PMID: 21566525 DOI: 10.1097/aud.0b013e318220377e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to investigate detection and differentiation of obligatory cortical auditory evoked potentials (CAEPs) in normal-hearing listeners with and without a simulated conductive hearing impairment using the HEARLab™. DESIGN Sound field CAEPs were obtained from 24 normal-hearing adults, with and without earplugs, using three natural speech sounds (/m/, /g/, and /t/) presented at 55, 65, and 75 dB SPL. RESULTS Response detection was good except for the lowest presentation level; however, differentiation of waveforms was generally poor for individual listeners. CONCLUSIONS Waveform differentiation was relatively poor, especially at low presentation levels, using the HEARLab's stimulus and analysis protocol.
Collapse
|
11
|
Paisansathan C, Ozcan MD, Khan QS, Baughman VL, Ozcan MS. Signal persistence of bispectral index and state entropy during surgical procedure under sedation. ScientificWorldJournal 2012; 2012:272815. [PMID: 22454604 PMCID: PMC3289978 DOI: 10.1100/2012/272815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/07/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Bispectral index (BIS) and state entropy (SE) are prone to artifacts, especially due to electrocautery (EC). We compared the incidence of artifacts in BIS and SE during surgery under local anesthesia and sedation. METHODS 28 females undergoing breast surgery under local anesthesia and sedation were studied. Simultaneous BIS and SE measurements were recorded every 10 seconds. Artifact was defined as a failure of the device to display a numerical value while the electrodes remained appropriately attached to the patient's forehead. Ratio of artifact to good signal was compared between BIS and SE in the presence or absence of EC use. RESULTS 7679 data points were collected from 28 patients. Overall, artifact incidence was similar in BIS and SE (6.2% and 6.3%, resp.). In the presence of EC (1370 data points), BIS had significantly more artifact compared to SE (18.6% versus 6.4%, P < 0.0001). Without EC (6309 data points), BIS had significantly less artifact compared to SE (4.1% versus 7.3%, P < 0.0001). DISCUSSION BIS and SE were comparable for incidence of artifacts in patients under sedation. Use of EC lead to more artifact in BIS than SE. Conversely, BIS had fewer artifacts than SE when there was no EC use.
Collapse
Affiliation(s)
- Chanannait Paisansathan
- Department of Anesthesiology, University of Illinois at Chicago, 1740 West Taylor Street, Suite 3200W, Chicago, IL 60612, USA
| | | | | | | | | |
Collapse
|
12
|
Fahlenkamp A, Peters D, Biener I, Billoet C, Apfel C, Rossaint R, Coburn M. Evaluation of bispectral index and auditory evoked potentials for hypnotic depth monitoring during balanced xenon anaesthesia compared with sevoflurane. Br J Anaesth 2010; 105:334-41. [DOI: 10.1093/bja/aeq163] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
13
|
|
14
|
Charabati S, Bracco D, Mathieu P, Hemmerling T. Comparison of four different display designs of a novel anaesthetic monitoring system, the ‘integrated monitor of anaesthesia (IMA™)’. Br J Anaesth 2009; 103:670-7. [DOI: 10.1093/bja/aep258] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Royl G, Füchtemeier M, Leithner C, Megow D, Offenhauser N, Steinbrink J, Kohl-Bareis M, Dirnagl U, Lindauer U. Hypothermia effects on neurovascular coupling and cerebral metabolic rate of oxygen. Neuroimage 2008; 40:1523-32. [PMID: 18343160 DOI: 10.1016/j.neuroimage.2008.01.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 01/22/2008] [Indexed: 10/22/2022] Open
Abstract
Neuronal activation is accompanied by a local increase in cerebral blood flow (CBF) and in cerebral metabolic rate of oxygen (CMRO(2)), caused by neurovascular and neurometabolic coupling. Hypothermia is used as a neuroprotective approach in surgical patients and therapeutically after cardiac arrest or stroke. The effect of hypothermia on neurovascular coupling is of interest for evaluating brain function in these patients, but has not been determined so far. It is not clear whether functional hyperaemia actually operates at subnormal temperatures. In addition, decreasing brain temperature reduces spontaneous CMRO(2) following a known quantitative relationship (Q(10)). Q(10) determination may serve to validate a recently introduced CMRO(2) measurement approach relying on optical measurements of CBF and hemoglobin concentration. We applied this method to investigate hypothermia in a functional study of the somatosensory cortex. Anesthetized Wistar rats underwent surgical implantation of a closed cranial window. Using laser Doppler flowmetry and optical spectroscopy, relative changes in CBF and hemoglobin concentration were measured continuously. At the same time, an electroencephalogram (EEG) was recorded from the measurement site. By the application of ice packs, whole-body hypothermia was induced, followed by rewarming. Spontaneous EEG, CBF and CMRO(2) were measured, interleaved by blocks of electrical forepaw stimulation. The Q(10) obtained from spontaneous CMRO(2) changes of 4.4 (95% confidence interval 3.7-5.1) was close to published values, indicating the reliability of the CMRO(2) measurement. Lowering brain temperature decreased functional changes of CBF and CMRO(2) as well as amplitudes of somatosensory evoked potentials (SEP) to the same degree. In conclusion, neurovascular and neurometabolic coupling is preserved during hypothermia.
Collapse
Affiliation(s)
- Georg Royl
- Department of Experimental Neurology, Charité Universitätsmedizin Berlin, 10098 Berlin, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kinney GA, Slimp JC. Intraoperative neurophysiological monitoring technology: recent advances and evolving uses. Expert Rev Med Devices 2007; 4:33-41. [PMID: 17187469 DOI: 10.1586/17434440.4.1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intraoperative neurophysiological monitoring has evolved over the last 25 years to become an important component of many types of orthopedic and neurosurgical procedures. From its foundations in VIII cranial nerve surgeries and scoliosis corrections surgeries, intraoperative neurophysiological monitoring has expanded to incorporate nearly all spine procedures and many involving the brain and brainstem. Fundamental to this growth in the use of intraoperative neurophysiological monitoring has been the development of the technology used to perform the neurophysiological tests. Advancements in electronics and computer technology have resulted in significant improvements in the capacity, ease of use, quality and reliability of the equipment as well as the quality of and control over the acquired data. These technological advancements have resulted in remarkable improvements in not only the quality and availability of intraoperative neurophysiological monitoring, but also, as a consequence, patient care, and have arguably propelled the expansion of the use that intraoperative neurophysiological monitoring has seen over the last 10 years.
Collapse
Affiliation(s)
- Gregory A Kinney
- Dept. of Rehabilitation Medicine, Harborview Medical Center, Box 359740, 325 9th Ave, Seattle, WA 98104, USA.
| | | |
Collapse
|
17
|
Abstract
IOM has become commonly used by many surgeons to enhance their intraoperative decision making and reduce the morbidity and mortality of selected procedures. The ability to perform these tests rests on the anesthesiologist's ability to provide the patient with an anesthetic plan that provides comfort and monitoring. When events occur, the anesthesiologist's knowledge and ability to manipulate the patient's physiologic condition become integral to the decision making. A good understanding of the neural anatomy, impact of physiology, and anesthetic medications can allow effective IOM and good team decision making when changes in IOM occur.
Collapse
Affiliation(s)
- Leslie C Jameson
- University of Colorado at Denver, Health Sciences Center, Campus Box B113, 4200 East 9th Avenue, Denver, CO 80262, USA.
| | | |
Collapse
|