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1.
Asian Journal of Andrology ; (6): 137-142, 2023.
Article in English | WPRIM | ID: wpr-970990

ABSTRACT

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.


Subject(s)
Male , Humans , Premature Ejaculation/surgery , Intraoperative Neurophysiological Monitoring/methods , Prospective Studies , Neurosurgical Procedures/methods , Penis/surgery , Retrospective Studies
3.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;34(4): 484-487, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020488

ABSTRACT

Abstract Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.


Subject(s)
Humans , Postoperative Complications/prevention & control , Drainage/instrumentation , Coronary Artery Bypass , Intraoperative Neurophysiological Monitoring/methods , Mediastinum/surgery , Pericardial Effusion/prevention & control , Drainage/methods , Feasibility Studies , Heart Ventricles/injuries
4.
Arq. bras. neurocir ; 36(3): 172-177, 08/09/2017.
Article in English | LILACS | ID: biblio-911205

ABSTRACT

The surgical techniques of spinal fusion are frequently used in the treatment of many spine conditions. Apart from having anatomical knowledge, in order to perform those procedures safely, it is essential to utilize all the tools available to assure the appropriate positioning of the materials and avoid neural injury. The goal of this article is to review the literature on the use of intraoperative neurophysiological monitoring for spinal fusion procedures and to discuss the controversies regarding this issue.


As técnicas cirúrgicas de fusão espinhal são frequentemente utilizadas no tratamento de muitas condições da coluna vertebral. Além do conhecimento anatômico, para realizar esses procedimentos com segurança é essencial utilizar todas as ferramentas disponíveis para assegurar o posicionamento adequado dos materiais e evitar lesões neurais. O objetivo deste artigo é revisar a literatura sobre o uso de monitorização neurofisiológica intraoperatória para procedimentos de fusão espinhal e discutir as controvérsias relacionadas a essa questão.


Subject(s)
Humans , Spinal Fusion/methods , Intraoperative Neurophysiological Monitoring , Intraoperative Neurophysiological Monitoring/methods
5.
Rev. bras. anestesiol ; Rev. bras. anestesiol;67(4): 370-375, July-aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-897730

ABSTRACT

Abstract Background and objectives: The Analgesia Nociception Index is an index used to measure the levels of pain, sympathetic system activity and heart rate variability during general anesthesia. In our study, Analgesia Nociception Index monitoring in two groups who had undergone spinal stabilization surgery and were administered propofol-remifentanil (Total Intravenous Anesthesia) and sevoflurane-remifentanyl anesthesia was compared regarding its significance for prediction of postoperative early pain. Methods: BIS and Analgesia Nociception Index monitoring were conducted in the patients together with standard monitoring. During induction, fentanyl 2 µg.kg-1, propofol 2.5 mg.kg-1 and rocuronium 0.6 mg.kg-1 were administered. During maintenance, 1.0 MAC sevoflurane + remifentanil 0.05-0.3 µg.kg-1.min-1 and propofol 50-150 µg.kg-1.min-1 + remifentanil 0.05-0.3 µg.kg-1.min-1 were administered in Group S and Group T, respectively. Hemodynamic parameters, BIS and Analgesia Nociception Index values were recorded during surgery and 30 min postoperatively. Postoperative visual analog scale (VAS) values at 30 minutes were recorded. Results: While no difference was found between mean Analgesia Nociception Index at all times of measurement in both groups, Analgesia Nociception Index measurements after administration of perioperative analgesic drug were recorded to be significantly higher compared to baseline values in both groups. There was correlation between mean values of Analgesia Nociception Index and VAS after anesthesia. Conclusion: Analgesia Nociception Index is a valuable parameter for monitoring of perioperative and postoperative analgesia. In spine surgery, similar analgesia can be provided in both Total Intravenous Anesthesia with remifentanil and sevoflurane administration. Analgesia Nociception Index is efficient for prediction of the need for analgesia during the early postoperative period, and therefore is the provision of patient comfort.


Resumo Justificativa e objetivos: O índice de analgesia/nocicepção (ANI) é usado para medir os níveis de dor, a atividade do sistema simpático e a variabilidade da frequência cardíaca durante a anestesia geral. Em nosso estudo, a monitoração do ANI em dois grupos que foram submetidos à cirurgia de estabilização da coluna vertebral e receberam propofol-remifentanil (Total Intravenous Anesthesia - TIVA) e sevoflurano-remifentanil foram comparados para identificar sua importância na previsão precoce de dor no pós-operatório. Métodos: Os pacientes foram monitorados com o uso de BIS e ANI juntamente com a monitoração padrão. Durante a indução, fentanil (2 µg.kg-1), propofol (2,5 mg.kg-1) e rocurônio (0,6 mg.kg-1) foram administrados. Durante a manutenção, 1 CAM de sevoflurano + remifentanil (0,05-0,3 µg.kg-1.min-1) e propofol (50-150 µg.kg-1.min-1) + remifentanil (0,05-0,3 µg.kg-1.min-1) foram administrados aos grupos S e T, respectivamente. Parâmetros hemodinâmicos, valores de BIS e ANI foram registrados durante a cirurgia e aos 30 minutos de pós-operatório. Os valores escala visual analógica (EVA) aos 30 minutos de pós-operatório foram registrados. Resultados: Enquanto não observamos diferença entre as médias do ANI em todos os tempos de mensuração de ambos os grupos, as mensurações do ANI após a administração do analgésico no perioperatório foram significativamente maiores do que os valores basais de ambos os grupos. Houve correlação entre as médias dos valores de ANI e EVA após a anestesia. Conclusão: ANI é um parâmetro importante para o monitoração de analgesia nos períodos perioperatório e pós-operatório. Na cirurgia da coluna vertebral, analgesia semelhante pode ser obtida com anestesia intravenosa total com remifentanil e com a administração de sevoflurano. O ANI é eficiente para prever a necessidade de analgesia durante o período pós-operatório imediato e, portanto, para proporcionar conforto ao paciente.


Subject(s)
Humans , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Spine/surgery , Pain Measurement , Orthopedic Procedures , Intraoperative Neurophysiological Monitoring/methods , Analgesia , Anesthesia, General , Sympathetic Nervous System/physiology , Heart Rate/physiology , Middle Aged
6.
Biomédica (Bogotá) ; Biomédica (Bogotá);35(3): 363-371, jul.-sep. 2015. ilus, graf, tab
Article in English | LILACS | ID: lil-765465

ABSTRACT

Introduction: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. Objective: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is cost-effective in a developing country. Materials and methods: We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. Results: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Conclusion: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.


Introducción. La tiroidectomía es una cirugía común. La búsqueda rutinaria del nervio laríngeo inferior es la estrategia más importante para evitar la parálisis. Objetivo. Evaluar el costo-efectividad en un país en desarrollo de la monitorización neurológica del nervio laríngeo inferior durante la tiroidectomía. Materiales y métodos. Se diseñó un análisis de decisiones para evaluar el costo-efectividad de la monitorización neurológica del nervio laríngeo inferior. Para las probabilidades se usaron datos de un meta-análisis. La utilidad se determinó con medidas de preferencia. Se incluyeron los costos directos. Se hizo un análisis determinístico y probabilístico. Resultados. No se encontraron diferencias en la utilidad entre las estrategias. La frecuencia de la lesión de este nervio fue de 1 % en el grupo bajo monitorización neurológica y de 1,6 % en el grupo de control. La tiroidectomía sin monitorización fue la alternativa menos costosa. La razón de costo-efectividad incremental fue de COP$ 9.112.065 Conclusión. La monitorización neurológica rutinaria en la tiroidectomía total con bajo riesgo de lesión del nervio laríngeo inferior, no es útil con relación a su costo ni costo-efectiva en el sistema de salud colombiano.


Subject(s)
Humans , Recurrent Laryngeal Nerve/physiology , Thyroidectomy/economics , Recurrent Laryngeal Nerve Injuries/prevention & control , Intraoperative Neurophysiological Monitoring/economics , Intraoperative Complications/prevention & control , Thyroidectomy/adverse effects , Tracheostomy/economics , Meta-Analysis as Topic , Probability , Decision Support Techniques , Cost-Benefit Analysis , Colombia , Unnecessary Procedures/economics , Developing Countries , Electric Stimulation/instrumentation , Electromyography/economics , Electromyography/instrumentation , Electromyography/methods , Intraoperative Neurophysiological Monitoring/instrumentation , Intraoperative Neurophysiological Monitoring/methods , Intubation, Intratracheal/instrumentation , Length of Stay/economics
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