BACKGROUND: Intraoperative monitoring during carotid endarterectomy is crucial for cerebral protection. We investigated the results of carotid endarterectomy under dual monitoring with stump pressure and electroencephalography. METHODS: We retrospectively reviewed the medical records of 50 patients who underwent carotid endarterectomy between March 2010 and February 2016. We inserted a temporary shunt if the stump pressure was lower than 35 mm Hg or if any intraoperative change was observed on electroencephalography. RESULTS: Seventeen (34%) patients used a temporary shunt, and the mean stump pressure was 26.8 mm Hg in the shunt group and 46.5 mm Hg in the non-shunt group. No postoperative mortality or bleeding occurred. Postoperatively, there were 3 cases (6%) of minor stroke, all of which took place in the shunt group. A comparison of the preoperative and the intraoperative characteristics of the shunt group with those of the non-shunt group revealed no statistically significant difference between the 2 groups (p <0.01). CONCLUSION: Dual monitoring with stump pressure and electroencephalography was found to be a safe and reliable monitoring method with results comparable to those obtained using single monitoring. Further study should be performed to investigate the precise role of each monitoring method.
Carotid Artery Diseases ; Electroencephalography* ; Endarterectomy, Carotid* ; Hemorrhage ; Humans ; Intraoperative Neurophysiological Monitoring ; Medical Records ; Methods ; Monitoring, Intraoperative ; Mortality ; Retrospective Studies ; Stroke

Selective dorsal neurotomy (SDN) is a surgical treatment for primary premature ejaculation (PE), but there is still no standard surgical procedure for selecting the branches of the dorsal penile nerves to be removed. We performed this study to explore the value of intraoperative neurophysiological monitoring (IONM) of the penile sensory-evoked potential (PSEP) for standard surgical procedures in SDN. One hundred and twenty primary PE patients undergoing SDN were selected as the PE group and 120 non-PE patients were selected as the normal group. The PSEP was monitored and compared between the two groups under both natural and general anesthesia (GA) states. In addition, patients in the PE group were randomly divided into the IONM group and the non-IONM group. During SDN surgery, PSEP parameters of the IONM group were recorded and analyzed. The differences in PE-related outcome measurements between the perioperative period and 3 months' postoperation were compared for the PE patients, and the differences in effectiveness and complications between the IONM group and the non-IONM group were compared. The results showed that the average latency of the PSEP in the PE group was shorter than that in the normal group under both natural and GA states (P < 0.001). Three months after surgery, the significant effective rates in the IONM and non-IONM groups were 63.6% and 34.0%, respectively (P < 0.01), and the difference in complications between the two groups was significant (P < 0.05). IONM might be useful in improving the short-term therapeutic effectiveness and reducing the complications of SDN.
Male ; Humans ; Premature Ejaculation/surgery* ; Intraoperative Neurophysiological Monitoring/methods* ; Prospective Studies ; Neurosurgical Procedures/methods* ; Penis/surgery* ; Retrospective Studies

PURPOSE: The perigastric vagus nerve may play an important role in preserving function after gastrectomy, and intraoperative neurophysiologic tests might represent a feasible method of evaluating the vagus nerve. The purpose of this study is to assess the feasibility of neurophysiologic evaluations of the function and viability of perigastric vagus nerve branches during gastrectomy. MATERIALS AND METHODS: Thirteen patients (1 open total gastrectomy, 1 laparoscopic total gastrectomy, and 11 laparoscopic distal gastrectomy) were prospectively enrolled. The hepatic and celiac branches of the vagus nerve were exposed, and grabbing type stimulation electrodes were applied as follows: 10–30 mA intensity, 4 trains, 1,000 µs/train, and 5× frequency. Visible myocontractile movement and electrical signals were monitored via needle probes before and after gastrectomy. Gastrointestinal symptoms were evaluated preoperatively and postoperatively at 3 weeks and 3 months, respectively. RESULTS: Responses were observed after stimulating the celiac branch in 10, 9, 10, and 6 patients in the antrum, pylorus, duodenum, and proximal jejunum, respectively. Ten patients responded to hepatic branch stimulation at the duodenum. After vagus-preserving distal gastrectomy, 2 patients lost responses to the celiac branch at the duodenum and jejunum (1 each), and 1 patient lost response to the hepatic branch at the duodenum. Significant procedure-related complications and meaningful postoperative diarrhea were not observed. CONCLUSIONS: Intraoperative neurophysiologic testing seems to be a feasible methodology for monitoring the perigastric vagus nerves. Innervation of the duodenum via the celiac branch and postoperative preservation of the function of the vagus nerves were confirmed in most patients. TRIAL REGISTRATION: Clinical Research Information Service Identifier: KCT0000823
Diarrhea ; Duodenum ; Electrodes ; Gastrectomy ; Humans ; Information Services ; Intraoperative Neurophysiological Monitoring ; Jejunum ; Methods ; Needles ; Prospective Studies ; Pylorus ; Vagus Nerve

Recently, intravenous sedatives and analgesics are being commonly used in children because of the clinical need for increasing the non-operating room anesthesia and intraoperative neurophysiologic monitoring during surgery and environmental problems. Administration methods (single bolus, intermittent bolus, or continuous infusion) vary according to the clinical request. Continuous intravenous anesthesia based on the weight is still the most commonly used method for administration of intravenous drugs in children. With the newly developed statistical method and medical devices, target controlled infusion of intravenous anesthetics has become possible in pediatric anesthesia, in spite of the difficulty in obtaining the specific pharmacokinetic model using pharmacokinetic parameters. Nowadays, a pharmacokinetic-pharmacodynamic model for complete effect-site target controlled infusion is available for use in children. Several drugs are used for pediatric sedation, such as analgesics or anesthetics such as opioids (remifentanil, sufentanil or alfentanil), neuromuscular blocking agents or sedatives (midazolam, dexmedetomidine). All these drugs have been used in continuous infusion via various methods including target controlled infusion. Many studies have been carried out by researchers to use target controlled infusion for safe and efficient treatment in children according to the increase in clinical demand. Various pharmacokinetic-pharmacodynamic models for commonly used intravenous drugs will be reviewed, with a focus on children in this small discussion.
Analgesics ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Intravenous ; Anesthetics ; Anesthetics, Intravenous ; Child* ; Humans ; Hypnotics and Sedatives ; Intraoperative Neurophysiological Monitoring ; Methods ; Neuromuscular Blocking Agents ; Sufentanil

Recently, intravenous sedatives and analgesics are being commonly used in children because of the clinical need for increasing the non-operating room anesthesia and intraoperative neurophysiologic monitoring during surgery and environmental problems. Administration methods (single bolus, intermittent bolus, or continuous infusion) vary according to the clinical request. Continuous intravenous anesthesia based on the weight is still the most commonly used method for administration of intravenous drugs in children. With the newly developed statistical method and medical devices, target controlled infusion of intravenous anesthetics has become possible in pediatric anesthesia, in spite of the difficulty in obtaining the specific pharmacokinetic model using pharmacokinetic parameters. Nowadays, a pharmacokinetic-pharmacodynamic model for complete effect-site target controlled infusion is available for use in children. Several drugs are used for pediatric sedation, such as analgesics or anesthetics such as opioids (remifentanil, sufentanil or alfentanil), neuromuscular blocking agents or sedatives (midazolam, dexmedetomidine). All these drugs have been used in continuous infusion via various methods including target controlled infusion. Many studies have been carried out by researchers to use target controlled infusion for safe and efficient treatment in children according to the increase in clinical demand. Various pharmacokinetic-pharmacodynamic models for commonly used intravenous drugs will be reviewed, with a focus on children in this small discussion.
Analgesics ; Analgesics, Opioid ; Anesthesia ; Anesthesia, Intravenous ; Anesthetics ; Anesthetics, Intravenous ; Child* ; Humans ; Hypnotics and Sedatives ; Intraoperative Neurophysiological Monitoring ; Methods ; Neuromuscular Blocking Agents ; Sufentanil

OBJECTIVE: To determine the maximum dose of continuously infused mivacurium for intraoperative neuromonitoring and observe its adverse effects in thyroid surgery. METHODS: Twenty-eight patients undergoing thyroid surgery with intraoperative neuromonitoring received continuous infusion of mivacurium at the initial rate of 5.43 μg?kg?min, and the infusion rate for the next patient was adjusted based on the response of the previous patient according to the results of neurological monitoring. The depth of anesthesia was maintained with sevoflurane and remifentanil during the surgery. The LD50 and 95% of mivacurium were calculated using Brownlee's up-and-down sequential method. RESULTS: The LD50 of continuously infused mivacurium was 8.94 μg?kg?min (95% : 8.89- 8.99 μg?kg?min) during thyroid surgery, which did not affect neurological function monitoring. Transient chest skin redness occurred after induction in 9 patients (32.1%). None of the patients experienced intubation difficulties or showed intraoperative body motions during the surgery. CONCLUSIONS In patients undergoing thyroid surgery under anesthesia maintained by inhalation and intravenous infusion, the LD50 of mivacurium was 8.94 μg?kg?min (95% : 8.89-8.99 μg?kg?min) for continuous infusion, which does not cause serious adverse effects during the operation.
Anesthesia ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Humans ; Intraoperative Neurophysiological Monitoring ; methods ; Lethal Dose 50 ; Mivacurium ; administration & dosage ; adverse effects ; Neuromuscular Nondepolarizing Agents ; administration & dosage ; adverse effects ; Remifentanil ; Sevoflurane ; Thyroid Gland ; surgery