RESUMO
OBJECTIVE: We developed a new minimally invasive method for intracranial pressure monitoring (ICPMI). The objective of this project is to verify the similarities between the ICPMI and the invasive method (ICPInv), for different components of the intracranial pressure signal-namely, the mean value (trend) as well as its pulsatile component. MATERIALS AND METHODS: A 9 kg anesthetized pig was used for simultaneous ICP monitoring with both methods. ICP was increased by performing ten infusions of 6 ml 0.9% saline into the spinal subarachnoid space, using a catheter implanted in the lumbar region. For correlation analysis, the signals were decomposed into two components-trend and pulsatile signals. Pearson correlation coefficient was calculated between ICPInv and ICPMI. RESULTS: During the infusions, the correlation between the pulsatile components of the signals was above 0.5 for most of the time. The signal trends showed a good agreement (correlation above 0.5) for most of the time during infusions. CONCLUSIONS: The ICPMI signal trends showed a good linear agreement with the signal obtained invasively. Based on the waveform analysis of the pulsatile component of ICP, our results indicate the possibility of using the minimally invasive method for assessing the neuroclinical state of the patient.
Assuntos
Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Monitorização Fisiológica/métodos , Osso Parietal , Animais , Infusão Espinal , Crânio , Espaço Subaracnóideo , SuínosRESUMO
OBJECTIVE: To investigate dosage changes in intrathecal baclofen during long-term treatment of patients with severe leg spasticity. METHODS: We performed a retrospective chart review of 49 patients treated with an intrathecal baclofen pump (ITB) because of severe leg spasticity, for a minimum of 7 years. Eight patients were excluded due to catheter/pump failure or factors aggravating spasticity. Of the remaining 41 patients, 19 had spinal cord injury (SCI) and 22 were diagnosed with multiple sclerosis (MS). Among the SCI patients, 15 had cervical and 4 thoracic SCI, with 7 patients showing the American Spinal Injury Association impairment scale (AIS) A and 12 patients with AIS B-D. The dose was regulated by discussion among the patients and their physicians, usually 4-10 times annually, to reduce leg spasticity and also avoid leg/trunk weakness. RESULTS: After 1 year patients on ITB needed a median dose of 168 mg/24 hr (range, 30-725 mg) for an optimal effect. After 7 to 10 years the dosage needed to reduce leg spasticity in the MS patients was significantly increased compared with the initial dose (mean 157%, n=22 and mean 194%, n=18). In contrast, the SCI patients needed only a modest increase (mean 113% and 121%). The difference between MS and SCI patients was significant (t-test p=0.006 and p=0.004). CONCLUSION: The increased dosage in MS patients compared with patients diagnosed with SCI probably reflects the progressive disease course. The need for a large dosage increase in patients with SCI suggests possible pump failure, triggering factors for spasticity or progressive spinal disease.
RESUMO
We present a case reported on the SENSAR database. A patient with a spinal infusion pump was admitted for reservoir refill. On administration of 22ml of 0.75% bupivacaine the patient suffered a total spinal block with widespread loss strength and respiratory arrest. The patient required emergency orotracheal intubation, mechanical ventilation and admission to ICU, where extubation was achieved within two hours without incidences. At a later stage it was stated that the local anaesthetic had been administered via the access port for bolus or contrast administration instead of via the access to the reservoir. Analysis of the incident showed up latent factors related to absence lack of personnel training and internal protocols. The following measures were taken: pain unit meeting, alert sent to SENSAR bulletin and training request for members of the service.