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Clinical feasibility and safety of transoesophageal motor-evoked potential monitoring.
Shiiya, Norihiko; Tsuda, Kazumasa; Yamanaka, Ken; Takahashi, Daisuke; Washiyama, Naoki; Yamashita, Katsushi; Kando, Yumi; Ohashi, Yuko.
Afiliação
  • Shiiya N; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Tsuda K; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Yamanaka K; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Takahashi D; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Washiyama N; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Yamashita K; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Kando Y; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
  • Ohashi Y; First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Eur J Cardiothorac Surg ; 57(6): 1076-1082, 2020 06 01.
Article em En | MEDLINE | ID: mdl-32011686
ABSTRACT

OBJECTIVES:

Canine experiments have shown that transoesophageal motor-evoked potential monitoring is feasible, safe and stable, with a quicker response to ischaemia and a better prognostic value than transcranial motor-evoked potentials. We aimed to elucidate whether or not these findings were clinically reproducible.

METHODS:

A bipolar oesophageal electrode mounted on a large-diameter silicon tube and a train of 5 biphasic wave stimuli were used for transoesophageal stimulation. Results of 18 patients (median age 74.5 years, 13 males) were analysed.

RESULTS:

There were no mortalities, spinal cord injuries or complications related with transoesophageal stimulation. Transcranial motor-evoked potential could not be monitored up to the end of surgery in 3 patients for unknown reasons, 2 of whom from the beginning. Transoesophageal motor-evoked potential became non-evocable after manipulation of a transoesophageal echo probe in 2 patients. Strenuous movement of the upper limbs during transoesophageal stimulation was observed in 3 patients. In 14 patients who successfully completed both monitoring methods up to the end of surgery (11 thoraco-abdominal and 3 descending aortic repair), the final results were judged as false positives in 6 by transcranial stimulation and in 1 by transoesophageal stimulation. The stimulation intensity was significantly lower and the upper limb amplitude was significantly higher by transoesophageal stimulation, while the lower limb amplitude was comparable.

CONCLUSIONS:

Transoesophageal motor-evoked potential monitoring is clinically feasible and safe with a low false positive rate. A better electrode design is required to avoid its migration by transoesophageal echo manipulation. Further studies may be warranted. CLINICAL REGISTRATION NUMBER UMIN000022320.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Traumatismos da Medula Espinal / Monitorização Intraoperatória Tipo de estudo: Prognostic_studies Limite: Aged / Animals / Humans / Male Idioma: En Revista: Eur J Cardiothorac Surg Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Traumatismos da Medula Espinal / Monitorização Intraoperatória Tipo de estudo: Prognostic_studies Limite: Aged / Animals / Humans / Male Idioma: En Revista: Eur J Cardiothorac Surg Ano de publicação: 2020 Tipo de documento: Article