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Chrysanthemum boreale Makino Inhibits Oxidative Stress-Induced Neuronal Damage in Human Neuroblastoma SH-SY5Y Cells by Suppressing MAPK-Regulated Apoptosis. Molecules 2022; 27:molecules27175498. [PMID: 36080264 PMCID: PMC9457777 DOI: 10.3390/molecules27175498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Oxidative stress has been demonstrated to play a pivotal role in the pathological processes of many neurodegenerative diseases. In the present study, we demonstrated that Chrysanthemum boreale Makino extract (CBME) suppresses oxidative stress-induced neurotoxicity in human neuroblastoma SH-SY5Y cells and elucidated the underlying molecular mechanism. Our observations revealed that CBME effectively protected neuronal cells against H2O2-induced cell death by preventing caspase-3 activation, Bax upregulation, Bcl-2 downregulation, activation of three mitogen-activated protein kinases (MAPKs), cAMP response element-binding protein (CREB) and NF-κB phosphorylation, and iNOS induction. These results provide evidence that CBME has remarkable neuroprotective properties in SH-SY5Y cells against oxidative damage, suggesting that the complementary or even alternative role of CBME in preventing and treating neurodegenerative diseases is worth further studies.
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Yan Q, Sun YS, An R, Liu F, Fang Q, Wang Z, Xu T, Chen L, Du J. Application and progress of the detection technologies in hepatocellular carcinoma. Genes Dis 2022. [PMID: 37492708 PMCID: PMC10363596 DOI: 10.1016/j.gendis.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Hepatocellular carcinoma (HCC) has a very high incidence and fatality rate, and in most cases, it is already at an advanced stage when diagnosed. Therefore, early prevention and detection of HCC are two of the most effective strategies. However, the methods recommended in the practice guidelines for the detection of HCC cannot guarantee high sensitivity and specificity except for the liver biopsy, which is known as the "gold standard". In this review, we divided the detection of HCC into pre-treatment diagnosis and post-treatment monitoring, and found that in addition to the traditional imaging detection and liver biopsy, alpha fetoprotein (AFP), lens culinaris-agglutinin-reactive fraction of AFP (AFP-L3), protein induced by vitamin K absence or antagonist-II (PIVKA-II) and other biomarkers are excellent biomarkers for HCC, especially when they are combined together. Most notably, the emerging liquid biopsy shows great promise in detecting HCC. In addition, lactic dehydrogenase (LDH), suppressor of cytokine signaling (SOCS) and other relevant biomarkers may become promising biomarkers for HCC post-treatment monitoring. Through the detailed introduction of the diagnostic technology of HCC, we can have a detailed understanding of its development process and then obtain some enlightenment from the diagnosis, to improve the diagnostic rate of HCC and reduce its mortality.
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Stienen MN, Fierstra J, Pangalu A, Regli L, Bozinov O. The Zurich Checklist for Safety in the Intraoperative Magnetic Resonance Imaging Suite: Technical Note. Oper Neurosurg (Hagerstown) 2020; 16:756-765. [PMID: 30099512 PMCID: PMC6531895 DOI: 10.1093/ons/opy205] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/06/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Recently, the use of intraoperative magnetic resonance imaging (ioMRI) has evolved in neurosurgery. Challenges related to ioMRI-augmented procedures are significant, since the magnetic field creates a potentially hazardous environment. Strict safety guidelines in the operating room (OR) are necessary. Checklists can minimize errors while increasing efficiency and improving workflow. OBJECTIVE To describe the Zurich checklists for safety in the ioMRI environment. METHODS We summarize the checklist protocol and the experience gained from over 300 surgical procedures performed over a 4-yr period using this new system for transcranial or transsphenoidal surgery in a 2-room high-field 3 Tesla ioMRI suite. RESULTS Particularities of the 2-room setting used at our institution can be summarized as (1) patient transfer from a sterile to a nonsterile environment and (2) patient transfer from a zone without to a zone with a high-strength magnetic field. Steps on the checklist have been introduced for reasons of efficient workflow, safety pertaining to the strength of the magnetic field, or sterility concerns. Each step in the checklist corresponds to a specific phase and particular actions taken during the workflow in the ioMRI suite. Most steps are relevant to any 2-room ioMRI-OR suite. CONCLUSION The use of an ioMRI-checklist promotes a zero-tolerance attitude for errors, can lower complications, and can help create an environment that is both efficient and safe for the patient and the OR personnel. We highly recommend the use of a surgical checklist when applying ioMRI.
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Affiliation(s)
- Martin N Stienen
- Department of Neurosurgery, Univer-sity Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuro-science Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, Univer-sity Hospital Zurich, University of Zurich, Zurich, Switzerland.,Clinical Neuro-science Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Athina Pangalu
- Clinical Neuro-science Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, Univer-sity Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, Univer-sity Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, Univer-sity Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Univer-sity Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neuroradiology, Univer-sity Hospital Zurich, University of Zurich, Zurich, Switzerland
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Tomita K, Nakada TA, Oshima T, Motoshima T, Kawaguchi R, Oda S. Tau protein as a diagnostic marker for diffuse axonal injury. PLoS One 2019; 14:e0214381. [PMID: 30901365 PMCID: PMC6430386 DOI: 10.1371/journal.pone.0214381] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/12/2019] [Indexed: 12/12/2022] Open
Abstract
Background Diffuse axonal injury (DAI) is difficult to identify in the early phase of traumatic brain injury (TBI) using common diagnostic methods. Tau protein is localized specifically in nerve axons. We hypothesized that serum level of tau can be a useful biomarker to diagnose DAI in the early phase of TBI. Methods & results We measured serum tau levels in 40 TBI patients who were suspected of DAI within 6 hours after TBI to evaluate the accuracy of the tau level as a diagnostic marker for DAI. Diagnosis of DAI was confirmed according to magnetic resonance imaging (MRI) findings. The serum tau level in the DAI group (n = 13) was significantly higher than that in the non-DAI group (n = 27) (DAI vs. non-DAI, 25.3 [0 to 99.1] pg/mL vs. 0 [0 to 44.4] pg/mL, P = 0.03)). A receiver-operating characteristic curve to evaluate the diagnostic ability of serum tau level within 6 hours for DAI showed an area under the curve of 0.690 with 74.1% for sensitivity and 69.2% for specificity. Serum tau level was not significantly higher in unfavorable outcome group (Glasgow Outcome scale [GOS] score = 1–3 at hospital discharge) compared with favorable outcome group (GOS score = 4–5) (P = 0.19). Conclusions Tau protein may be a useful biomarker for diagnosis of DAI in the early phase of TBI.
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Affiliation(s)
- Keisuke Tomita
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Taka-aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
- * E-mail:
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takayuki Motoshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Rui Kawaguchi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shigeto Oda
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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Esen A, Calim M, Kadioglu H. MRI and Anesthesia & Sedation. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2017. [DOI: 10.25000/acem.319865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Rahmathulla G, Recinos PF, Traul DE, Avitsian R, Yunak M, Harper NT, Barnett GH, Recinos VR. Surgical briefings, checklists, and the creation of an environment of safety in the neurosurgical intraoperative magnetic resonance imaging suite. Neurosurg Focus 2012; 33:E12. [DOI: 10.3171/2012.9.focus12260] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Technological advances have made it possible to seamlessly integrate modern neuroimaging into the neurosurgical operative environment. This integration has introduced many new applications improving surgical treatments. One major addition to the neurosurgical armamentarium is intraoperative navigation and MRI, enabling real-time use during surgery. In the 1970s, the American College of Radiology issued safety guidelines for diagnostic MRI facilities. Until now, however, no such guidelines existed for the MRI-integrated operating room, which is a high-risk zone requiring standardized protocols to ensure the safety of both the patient and the operating room staff. The forces associated with the strong 1.5- and 3.0-T magnets used for MRI are potent and hazardous, creating distinct concerns regarding safety, infection control, and image interpretation. Authors of this paper provide an overview of the intraoperative MRI operating room, safety considerations, and a series of checklists and protocols for maintaining safety in this zero tolerance environment.
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Affiliation(s)
- Gazanfar Rahmathulla
- 1Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 2Departments of Neurosurgery and
- 3Neurological Institute
| | - Pablo F. Recinos
- 1Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 2Departments of Neurosurgery and
- 4Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | - Gene H. Barnett
- 1Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 2Departments of Neurosurgery and
- 3Neurological Institute
| | - Violette Renard Recinos
- 1Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center
- 2Departments of Neurosurgery and
- 3Neurological Institute
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Mueller CA, Peters I, Podlogar M, Kovacs A, Urbach H, Schaller K, Schramm J, Kral T. Vertebral artery injuries following cervical spine trauma: a prospective observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20:2202-9. [PMID: 21717238 DOI: 10.1007/s00586-011-1887-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 04/30/2011] [Accepted: 06/11/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to report on the incidence, diagnosis and clinical manifestation of VAI following cervical spine injuries observed in a prospective observational study with a standardized clinical and radiographical protocol. METHODS During a 16-year period, 69 (mean age: 43 ± 20.7 years; 25 female, 44 male) of 599 patients had cervical spine injury suspicious for VAI due to facet luxation and/or fractures extending into the transverse foramen. Diagnosis and management of these patients followed a previously published protocol (Kral in Zentralbl Neurochir 63:153-158, 2002). Digital subtraction angiography (DSA) was performed in all 69 patients. Injury grading of VAI was done according to Biffl et al. (Ann Surg 231:672-681, 2000). All patients with VAI were treated with anticoagulation (heparin followed by ASS) for 6 months. RESULTS In cases suspicious for VAI, the incidence of VAI detected by DSA was 27.5% (n = 19 of 69 patients). VAI Grade I occurred in 15.8%, Grade II in 26.3%, Grade IV in 52.6% and Grade V in 5.2%. Of 19 patients, 4 (21%) had clinical signs of vertebrobasilar ischemia. Two patients died in hospital after 4 and 21 days respectively. Of 69 patients, 33 (47.8%) with suspected VAI had unstable spine injuries and were treated surgically. CONCLUSION In patients with cervical spine fractures or dislocations crossing the course of the vertebral artery, VAI are relatively frequent and may be associated with significant morbidity and mortality. VAI were identified by DSA in 27.5%. Despite anticoagulation therapy, 5.8% became clinically symptomatic and 2.9% died due to cerebrovascular ischemia.
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Affiliation(s)
- Christian-Andreas Mueller
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms Universität Bonn, Sigmund-Freud Str. 25, 53105 Bonn, Germany.
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Smith JA. Hazards, Safety, and Anesthetic Considerations for Magnetic Resonance Imaging. Top Companion Anim Med 2010; 25:98-106. [DOI: 10.1053/j.tcam.2010.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/21/2010] [Indexed: 11/11/2022]
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Increased Risk of General Anesthesia for High-Risk Patients Undergoing Magnetic Resonance Imaging. J Comput Assist Tomogr 2009; 33:312-5. [DOI: 10.1097/rct.0b013e31818474b8] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Deckert D, Zecha-Stallinger A, Haas T, von Goedecke A, Lederer W, Wenzel V. Anästhesie außerhalb des Zentral-OP. Anaesthesist 2007; 56:1028-30, 1032-7. [PMID: 17565474 DOI: 10.1007/s00101-007-1216-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The number of diagnostic and surgical procedures being performed outside the core operating area is growing disproportionately. Due to the higher perioperative risk for such patients, anesthesia should only be provided by a very experienced anesthesiologist, even for supposedly small interventions. At these locations, timely and direct access to the anesthesia machine and/or the patient is often limited and if additional personnel or supplies are required, substantial time delays usually occur and should be allowed for. Standard operating procedures that are optimized to local requirements and providing a specially equipped anesthesia trolley for diagnostic and surgical procedures outside of the core operating area, may decrease the likelihood of complications induced by poorly equipped anesthesia workplaces. For electroconvulsive therapy (ECT), the standard drugs are methohexital in combination with short-acting opioids, such as remifentanil and succinylcholine. Significant variations in arterial blood pressure and heart rate are possible. Anesthesia induction in children with a known difficult airway or difficult intravascular access should initially be performed in a location with optimal infrastructure with subsequent transfer to the diagnostic or surgical suite outside the core operating area. Before entering the magnetic resonance imaging (MRI) suite, personal ferromagnetic items (e.g. pens, credit cards, stethoscopes, keys, telephones, USB sticks) should be removed to prevent injury and data loss; a MRI-compatible anesthesia machine and equipment is compulsory. Patients with cardiac pacemakers, cochlea implants, aneurysm or other clips, metallic-based tattoos or make-up are not normally compatible with MRI. General anesthesia should be preferred over conscious sedation for magnetic resonance imaging and ear protection is necessary for anesthetized patients. Gastroscopy in children should be performed under general anesthesia; and when concluding the procedure, air insufflated into the gastrointestinal tract should be suctioned in all patients. For angiography, maximum monitoring needs to be available to provide hemodynamically unstable patients with adequate anesthesia care; comprehensive radiation protection for patients and staff as well as temperature monitoring for prolonged diagnostic procedures is also necessary. Monitoring oxygen saturation and end-tidal carbon dioxide as well as employing visual and audible alarms is an essential requirement even during conscious sedation. In summary, the number of diagnostic and surgical procedures performed outside the core operating area should be reduced to a minimum and, whenever possible, diagnostic or surgical procedures should be performed within the core operating area.
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Affiliation(s)
- D Deckert
- Univ.-Klinik für Anästhesie und Allgemeine Intensivmedizin, Medizinische Universität Innsbruck, Innsbruck, Osterreich.
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v Paczynski S, Braun KP, Müller-Forell W, Werner C. Fallgruben in der Magnetresonanztomographie. Anaesthesist 2007; 56:797-804. [PMID: 17505810 DOI: 10.1007/s00101-007-1202-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The constantly extending indication spectrum of magnetic resonance imaging (MRI) is a challenge for the anaesthesiologist, who is being increasingly more consulted for assistance during the examination. Due to the special technology of MRI the anaesthetic technique differs substantially from that in the operating theatre. In addition to the permanent strong magnetic field the intermittently used high frequency impulses are also a potential danger for the patient. Patients with metal implants (e.g. cardiac pacemaker) are particularly at risk. For the safe treatment of patients during MRI a special MRI compatible anaesthesia equipment is necessary. Unsuitable devices can lead to malfunctioning or to projectile effects (attracting ferromagnetic objects into the magnet) causing injury to the patients. This paper describes the MRI technology and the associated dangers for the patient as well as the characteristics of the anaesthetic techniques.
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Affiliation(s)
- S v Paczynski
- Klinik für Anästhesiologie, Johannes Gutenberg-Universität, Langenbeckstrasse 1, 55101 Mainz.
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Abstract
The past year has seen a number of reports discussing the future possibilities of image-guided surgery and interventional radiology. One of the most exciting developments is intra-operative magnetic resonance imaging. The anaesthesiologist plays a central role in these developments, ensuring that patients undergoing procedures in the radiology department are adequately monitored and safely maintained.
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Affiliation(s)
- C J Peden
- Department of Anaesthesia, Royal United Hospital, Bath, UK.
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Larenza MP, Bergadano A, Iff I, Doherr MG, Schatzmann U. Comparison of the cardiopulmonary effects of anesthesia maintained by continuous infusion of ketamine and propofol with anesthesia maintained by inhalation of sevoflurane in goats undergoing magnetic resonance imaging. Am J Vet Res 2006; 66:2135-41. [PMID: 16379659 DOI: 10.2460/ajvr.2005.66.2135] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the cardiopulmonary effects of anesthesia maintained by continuous infusion of ketamine and propofol with anesthesia maintained by inhalation of sevoflurane in goats undergoing magnetic resonance imaging. ANIMALS 8 Saanen goats. PROCEDURES Goats were anesthetized twice (1-month interval) following sedation with midazolam (0.4 mg/kg, IV). Anesthesia was induced via IV administration of ketamine (3 mg/kg) and propofol (1 mg/kg) and maintained with an IV infusion of ketamine (0.03 mg/kg/min) and propofol (0.3 mg/kg/min) and 100% inspired oxygen (K-P treatment) or induced via IV administration of propofol (4 mg/kg) and maintained via inhalation of sevoflurane in oxygen (end-expired concentration, 2.3%; 1X minimum alveolar concentration; SEVO treatment). Cardiopulmonary and blood gas variables were assessed at intervals after induction of anesthesia. RESULTS Mean +/- SD end-expired sevoflurane was 2.24 +/- 0.2%; ketamine and propofol were infused at rates of 0.03 +/- 0.002 mg/kg/min and 0.29 +/- 0.02 mg/kg/min, respectively. Overall, administration of ketamine and propofol for total IV anesthesia was associated with a degree of immobility and effects on cardiopulmonary parameters that were comparable to those associated with anesthesia maintained by inhalation of sevoflurane. Compared with the K-P treatment group, mean and diastolic blood pressure values in the SEVO treatment group were significantly lower at most or all time points after induction of anesthesia. After both treatments, recovery from anesthesia was good or excellent. CONCLUSIONS AND CLINICAL RELEVANCE Results suggest that ketamine-propofol total IV anesthesia in goats breathing 100% oxygen is practical and safe for performance of magnetic resonance imaging procedures.
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Affiliation(s)
- M Paula Larenza
- Division of Anesthesiology, Department of Clinical Veterinary Sciences, VetSuisse Faculty, University of Berne, Länggassstrasse 124, PO Box 8466, CH-3012 Berne, Switzerland
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de Kerviler E, de Bazelaire C, Mathieu O, Albiter M, Frija J. Risque IRM : règles de sécurité, incidents et accidents. ACTA ACUST UNITED AC 2005; 86:573-8. [PMID: 16106796 DOI: 10.1016/s0221-0363(05)81410-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is now accepted that MR imaging does not present any biological risk for humans, even in cases of repeated exposure. However, several of the MR components (magnetic field, gradients, RF pulses, electrodes...) may cause some inconveniences to patients, most of them being reversible. However, severe accidents have been reported. Even though screening of patients for MR imaging eligibility is performed to identify patients with contra-indications to MRI, the lack of vigilance or the ignorance of certain basic safety requirements could lead to serious adverse effects, including death. The goal of this article is to review the various accidents reported with MRI, to explain their mechanism, and to describe means of prevention.
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Affiliation(s)
- E de Kerviler
- Service de Radiologie, Hôpital Saint-Louis, Claude-Vellefaux, Paris.
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Ruschulte H, Piepenbrock S, Münte S, Lotz J. Severe burns during magnetic resonance examination. Eur J Anaesthesiol 2005; 22:319-20. [PMID: 15892416 DOI: 10.1017/s0265021505250536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
PURPOSE OF REVIEW This review focuses on the technological principles, safety considerations, monitors and equipment, patient issues, and a general overview of the anesthetic management of both conventional and intraoperative magnetic resonance imaging based on the most recent literature. RECENT FINDINGS As a diagnostic imaging modality, magnetic resonance imaging remains unparalleled in its diagnostic and clinical value. The clinical applications for magnetic resonance imaging continue to evolve, and include its latest use in minimally invasive procedures as well as in the operating room. Intraoperative magnetic resonance imaging is steadily gaining acceptance for neurosurgical procedures. The safety considerations, monitor and equipment issues for intraoperative magnetic resonance imaging are similar to the conventional setting. However, they differ in their focus on anesthesia management. Most monitoring compatible with magnetic resonance imaging has been available for many years. In the USA, the newest available monitoring option during magnetic resonance imaging is for temperature. This option has been available in other countries for a number of years. A fiberoptic surface sensor provides a safe and accurate monitor of adult, pediatric, and neonatal body temperature. SUMMARY The magnetic resonance imaging suite is a challenging environment for the anesthesiologist, and carries inherent risks. Several factors account for this, including the remote location, the unique features of the magnetic resonance imaging scanner, and patient-related factors. Understanding the implications of the magnetic resonance imaging environment will facilitate ensuring the safety of the patient and personnel.
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Affiliation(s)
- Cheryl K Gooden
- Department of Anesthesiology, Mount Sinai Medical Center, New York, New York 10029, USA.
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Alspach D, Falleroni M. Monitoring Patients During Procedures Conducted Outside the Operating Room. Int Anesthesiol Clin 2004; 42:95-111. [PMID: 15087743 DOI: 10.1097/00004311-200404220-00008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- David Alspach
- Department of Anesthesiology, Evanston Northwestern Healthcare, IL 60201, USA
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Affiliation(s)
- Cheryl K Gooden
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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McBrien ME, Winder J, Smyth L. Anaesthesia for magnetic resonance imaging: a survey of current practice in the UK and Ireland. Anaesthesia 2000; 55:737-43. [PMID: 10947685 DOI: 10.1046/j.1365-2044.2000.01322.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The lack of information about standards for anaesthetic practice in magnetic resonance imaging is of concern, since increasing requests are being made for this service, often in units not designed for the purpose. An overview of current practice was sought by conducting a postal survey of magnetic resonance units in the UK and Ireland. Replies were received from 100 units (79%), 46 of which had an anaesthetic service provided. A wide diversity of practice and opinion on the conduct of anaesthesia in this field was evident from the replies received. The survey highlighted particular areas of concern about the personal safety of anaesthetists within such units, including exposure to magnetic fields, noise and unscavenged anaesthetic gases. The evidence for such concerns is reviewed.
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Affiliation(s)
- M E McBrien
- Department of Anaesthesia, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, UK
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Adewale L, Dearlove O, Wilson B, Hindle K, Robinson DN. The caudal canal in children: a study using magnetic resonance imaging. Paediatr Anaesth 2000; 10:137-41. [PMID: 10736075 DOI: 10.1046/j.1460-9592.2000.00462.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The anatomy of the caudal (sacral extradural) space was studied in 41 children, using magnetic resonance imaging. The distance from the upper margin of the sacrococcygeal membrane to the dural sac, the length of the membrane and the maximum depth of the caudal space were each measured. Age, height, weight and body surface area were recorded and, using multiple linear regression (stepwise technique), equations predicting the length of the membrane and the distance between its upper margin and the lower limit of the dural sac were obtained. Wide variability limits the clinical usefulness of these equations. In all patients, the maximum depth of the caudal space was found to be at the upper margin of the sacrococcygeal membrane. No correlation was found between this maximum depth and the age, height, weight or body surface area of the child.
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Affiliation(s)
- L Adewale
- Royal Manchester Children's Hospital, Pendlebury, Manchester M27 4HA, UK
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Abstract
Developments in technology have led to the merger of two distinct environments, that of magnetic resonance imaging and that of the operating room. The major advantage of this merger for neurosurgical procedures is the ability to perform real-time imaging to help guide surgery. This review discusses the role of the anesthesiologist in the planning and administration of safe anesthesia in this new and challenging environment.
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Affiliation(s)
- P H Manninen
- Department of Anesthesia, Toronto Western Hospital, University Health Network, Ontario, Canada
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Lloyd Jones S, Mason RA. Laser surgery in a patient with Romano-Ward (long QT) syndrome and an automatic implantable cardioverter defibrillator. Anaesthesia 2000; 55:362-6. [PMID: 10781123 DOI: 10.1046/j.1365-2044.2000.01167.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 48-year-old woman with Romano-Ward syndrome (a hereditary long QT syndrome), asthma and an automatic implantable cardioverter defibrillator presented for laser surgery for debulking of a massive nasopharyngeal tumour prior to radiotherapy. Automatic implantable cardioverter defibrillators have only relatively recently been used to treat patients with the long QT syndrome and are indicated for the high-risk individual when conventional treatment has failed or when beta-blockers are contraindicated. If surgery requires the use of surgical diathermy, a cardiac technician must be present to deactivate the defibrillator and external pacing electrodes are sited on the chest until the defibrillator can be reactivated. Radiotherapy requires both deactivation and shielding of the device.
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Affiliation(s)
- S Lloyd Jones
- Department of Anaesthesia, Swansea NHS Trust, Singleton Hospital, Sketty Lane, Swansea SA2 8QA
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Summors A, Menon D. Anaesthesia and sedation for neuroradiological imaging and interventional neuroradiology. Best Pract Res Clin Anaesthesiol 1999. [DOI: 10.1053/bean.1999.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Williams EJ, Jones NS, Carpenter TA, Bunch CS, Menon DK. Testing of adult and paediatric ventilators for use in a magnetic resonance imaging unit. Anaesthesia 1999; 54:969-74. [PMID: 10540062 DOI: 10.1046/j.1365-2044.1999.01009.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We have assessed the performance of a series of ventilators (modified versions of the ventiPAC, paraPAC and babyPAC ventilators; SIMS pneuPAC Ltd, Luton, UK) in a magnetic resonance imaging (MRI) scanning environment, with MR safety and compatibility issues being addressed. Following initial modifications to remove ferromagnetic components and replace them with MR-safe materials, all three ventilators performed well in a series of tests in static magnetic fields up to 2 T. Ventilator performance was unaffected by static fields, switching gradients or radio frequency fields within the MR suite. Furthermore, the devices produced no degradation of image quality when used during MR scanning. We discuss management strategies for the care of critically ill ventilated patients during MR procedures.
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Affiliation(s)
- E J Williams
- Wolfson Brain Imaging Centre, School of Clinical Medicine, Box 65, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
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Abstract
Technical innovations in neuroimaging have improved diagnosis and prognosis, whereas developments in interventional neuroradiology have extended the range of therapy to different patient populations. These changes in service demand the identification of those clinical and technical factors distinguishing feasibility from futility, in order to increase population efficiency and reduce the harm associated with inappropriate therapy.
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Affiliation(s)
- M J Souter
- Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK.
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Macmillan CSA, Wild JM, Andrews PJD, Marshall I, Armitage PA, Wardlaw JM, Easton VJ, Cannon J. Accuracy of a Miniature Intracranial Pressure Monitor, Its Function during Magnetic Resonance Scanning, and Assessment of Image Artifact Generation. Neurosurgery 1999. [DOI: 10.1227/00006123-199907000-00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Affiliation(s)
- P H Manninen
- Department of Anaesthesia, Toronto Hospital, Ontario
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Matteson SR, Deahl ST, Alder ME, Nummikoski PV. Advanced imaging methods. CRITICAL REVIEWS IN ORAL BIOLOGY AND MEDICINE : AN OFFICIAL PUBLICATION OF THE AMERICAN ASSOCIATION OF ORAL BIOLOGISTS 1996; 7:346-95. [PMID: 8986396 DOI: 10.1177/10454411960070040401] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recent developments in imaging sciences have enabled dental researchers to visualize structural and biophysical changes effectively. New approaches for intra-oral radiography allow investigators to conduct densitometric assessments of dento-alveolar structures. Longitudinal changes in alveolar bone can be studied by computer-assisted image analysis programs. These techniques have been applied to dimensional analysis of the alveolar crest, detection of gain or loss of alveolar bone density, peri-implant bone healing, and caries detection. Dental applications of computed tomography (CT) include the detailed radiologic anatomy of alveolar processes, orofacial soft tissues and air spaces, and developmental defects. Image analysis software permits bone mass mineralization to be quantified by means of CT data. CT has also been used to study salivary gland disease, injuries of the facial skeleton, and dental implant treatment planning. Magnetic resonance imaging (MRI) has been used extensively in retrospective and prospective studies of internal derangements of the temporomandibular joint. Assessments based on MRI imaging of the salivary glands, paranasal sinuses, and cerebrovascular disease have also been reported. Magnetic resonance spectroscopy (MRS) has been applied to the study of skeletal muscle, tumors, and to monitor the healing of grafts. Nuclear imaging provides a sensitive technique for early detection of physiological changes in soft tissue and bone. It has been used in studies of periodontitis, osteomyelitis, oral and maxillofacial tumors, stress fractures, bone healing, temporomandibular joint, and blood flow. This article includes brief descriptions of the technical principles of each imaging modality, reviews their previous uses in oral biology research, and discusses potential future applications in research protocols.
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Affiliation(s)
- S R Matteson
- Department of Dental Diagnostic Science, University of Texas Health Science Center, San Antonio 78284-7919, USA
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Paediatric anaesthesia outside the operating room. Can J Anaesth 1995. [DOI: 10.1007/bf03011021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Steib A, Schwartz E, Stojeba N, Gengenwin N, Hartmann G. [Anesthesia for MRI examination]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1994; 13:373-380. [PMID: 7992944 DOI: 10.1016/s0750-7658(94)80045-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Magnetic resonance imaging (MRI) requires the patients to stay for 30-45 min in a magnetic closed noisy space. Therefore most children and agitated adults require general anaesthesia or sedation in order to high quality images. Anaesthesia may be given by several routes (TIVA, inhalational or intrarectal administration) using common drugs. However, the magnetic field limits the selection of patients undergoing MRI and the spectrum of anaesthetic and monitoring equipment. The magnetic field may have deleterious effects on implanted ferromagnetic devices. It may attract objects towards the magnet centre at a dangerous speed. Moreover it may disturb the function of monitors and anaesthesia machines which should be tested for a specific magnetic field strength before introducing their use in a given MRI unit.
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Affiliation(s)
- A Steib
- Service d'Anesthésie et de Réanimation Chirurgicale, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Strasbourg
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Peden CJ, Menon DK, Hall AS, Sargentoni J, Whitwam JG. Magnetic resonance for the anaesthetist. Part II: Anaesthesia and monitoring in MR units. Anaesthesia 1992; 47:508-17. [PMID: 1616091 DOI: 10.1111/j.1365-2044.1992.tb02278.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Anaesthetists are increasingly involved in patient care during magnetic resonance imaging and spectroscopy. This paper describes a system which has been developed for the management of critically ill patients and the conduct of anaesthesia in a magnetic resonance unit with a 1.6 tesla whole body magnet. Difficulties which arise from working in a confined space in a high magnetic field are highlighted. Different approaches to anaesthesia, sedation and the modification of equipment for use in this environment are reviewed. The problems associated with patient monitoring within a magnetic field are discussed and some solutions are suggested. A transport system for critically ill patients is described and a protocol for management is outlined.
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