Toxicology Screening Testing in Patients Undergoing Spine Surgery: A Prospective Observational Pilot Study.

BACKGROUND: Chronic opioid use and polypharmacy are commonly seen in chronic pain patients presenting for spine procedures. Substance abuse and misuse have also been reported in this patient population. Negative perioperative effects have been found in patients exposed to chronic opioid, alcohol, and recreational substances. Toxicology screening testing (TST) in the perioperative period provides useful information for adequate preoperative optimization and perioperative planning. METHODS: We designed a pilot study to understand this population's preoperative habits including accuracy of self-report and TST-detected prescribed and unprescribed medications and recreational substances. We compared the results of the TST to the self-reported medications using Spearman correlations. RESULTS: Inconsistencies between TST and self-report were found in 88% of patients. Spearman correlation was 0.509 between polypharmacy and intraoperative propofol use, suggesting that propofol requirement increased as the number of substances used increased. CONCLUSIONS: TST in patients presenting for spine surgery is a useful tool to detect substances taken by patients because self-report is often inaccurate. Discrepancies decrease the opportunity for preoperative optimization and adequate perioperative preparation.

Changes in phase-angle under light-dark cycles influenced by nonphotic stimulation.

Most work looking at nonphotic effects on circadian rhythms is conducted when animals are held under freerunning conditions, usually constant darkness. However, for nonphotic effects to be functionally significant, they should be demonstrable under conditions in which most animals live, i.e., a 24-hr light-dark cycle (LD). Syrian hamsters held in LD 6:18 were administered nonphotic stimulation in the form of a 3-hr confinement to a novel wheel starting about 6 hr before the start of their normal nightly activity bout. This resulted in a 2.5-hr advance of their activity rhythm on the next day that gradually receded to about 1.5 hr over the next 10 days. When hamsters held in LD 6:18 were given five novel wheel confinements over 13 days their nightly activity onset advanced 3 hr and remained at that phase for at least 2 weeks. Home cage wheel deprivation experiments indicated that high levels of home cage activity are necessary to maintain the advanced phase. These results show that nonphotic stimulation can have large, long-lasting effects on daily rhythms in LD and suggest a possible mechanism whereby nocturnal rodents might achieve phase flexibility in response to seasonal changes.

Intraoperative autologous transfusion of hemolyzed blood.

During two cases of lumbar spine surgery with instrumentation, we used intraoperative autologous transfusion (IAT), resulting in hemolysis during collection and hemoglobinuria and coagulation abnormalities after transfusion. Hemolysis during IAT collection can lead to hemoglobinuria and binding of nitric oxide, leading to vasoconstriction. The literature suggests that stroma from damaged cells and contact of the blood with the IAT device can lead to coagulation abnormalities and other morbidities, including adult respiratory distress syndrome.

Multimodality monitoring of the central nervous system using motor-evoked potentials.

PURPOSE OF REVIEW: This review was conducted to examine the role of motor-evoked potential monitoring in spine and central nervous system surgery to determine whether other monitoring modalities such as the wake-up test or somatosensory-evoked potentials can be eliminated. RECENT FINDINGS: The current literature suggests that motor-evoked potential, despite some advantages, still requires that other monitoring modalities such as somatosensory-evoked potentials or electromyography be used to provide optimal monitoring. SUMMARY: The literature supports the use of multimodality monitoring using all of the electrophysiological techniques that can provide intraoperative information about the neural structures at risk during the surgery.

Electrophysiologic monitoring in neurosurgery.

Electrophysiologic techniques have become common in the neurosurgical operating room. This article reviews the methods used for mapping neural structures or monitoring during surgery. Mapping methods allow identification of target structures for surgery, or for identifying structures to allow avoidance or plot safe pathways to deeper structures. Monitoring methods allow for surgery on nearby structures to warn of encroachment, thereby reducing unwanted injury.

Nonphotic phase shifting in female Syrian hamsters: interactions with the estrous cycle.

Nonphotic phase shifting of circadian rhythms was examined in female Syrian hamsters. Animals were stimulated at zeitgeber time 4.5 by either placing them in a novel running wheel or by transferring them to a clean home cage. Placement in a clean home cage was more effective than novel wheel treatment in stimulating large (> 1.5 h) phase shifts. Peak phase shifts (ca. 3.5 h) and the percentage of females showing large phase shifts were comparable to those found in male hamsters stimulated with novel wheels. The amount of activity induced by nonphotic stimulation and the amount of phase shifting varied slightly with respect to the 4-day estrous cycle. Animals tended to run less and shift less on the day of estrus. Nonphotic stimulation on proestrus often resulted in a 1-day delay of the estrous cycle reflected in animals' postovulatory vaginal discharge and the expression of sexual receptivity (lordosis). This delay of the estrous cycle was associated with large phase advances and high activity. These results extend the generality of nonphotic phase shifting to females for the first time and raise the possibility that resetting of circadian rhythms can induce changes in the estrous cycle.