ABSTRACT
The objective of this study is to determine the role of multimodal intraoperative neurophysiologic monitoring (IONM) in the overall outcome of intracranial aneurysms surgery, and the risk factors associated with ischemic complications. We grouped 268 ruptured and unruptured intracranial aneurysms surgically treated at our institution into 2 cohorts, based on the use of IONM (180; 67.16%) or non-use of IONM (88; 32.84%). The IONM technique used was multimodal: electroencephalogram (EEG), somatosensory evoked potentials (SSEPs), transcranial (TES), and direct cortical (DCS) stimulation motor evoked potentials (MEPs). There was a significant difference, with a reduction in perioperative strokes (p = 0.011) and better motor surgery-related outcome in the IONM group (p = 0.016). Independent risk factors identified for surgery ischemic complications were temporary clipping time ≥ 6'05â³ (odds ratio [OR]: 3.03; 95% CI: 1.068-8.601; p = 0.037), aneurysm size ≥ 7.5 mm (OR: 2.65; 95% CI: 1.127-6.235; p = 0.026), and non-use of IONM (OR: 2.79; 95% CI: 1.171-6.636; p = 0.021). Conversely, aneurysm rupture was not detected as an independent risk factor (OR: 2.5; 95% CI: 0.55-4.55; p = 0.4). Longer temporary clipping time, larger aneurysm size, and the non-use of IONM could be considered as risk factors for ischemic complications during microsurgical clipping. A standardized designed protocol including multimodal IONM with DCS provides continuous information about blood supply and allows reduction of treatment-related morbidity. Multimodal IONM is a valuable technique in intracranial aneurysm surgery.
Subject(s)
Intracranial Aneurysm , Intraoperative Neurophysiological Monitoring , Evoked Potentials, Motor/physiology , Evoked Potentials, Somatosensory/physiology , Humans , Intracranial Aneurysm/surgery , Intraoperative Neurophysiological Monitoring/methods , Retrospective StudiesABSTRACT
Se describe un caso de afectación del nervio hipogloso después de un recambio de hemiartroplastia de hombro con anestesia general con intubación orotraqueal sin complicaciones. Previamente se había realizado un bloqueo interescalénico guiado por ultrasonidos con el paciente despierto. La cirugía se llevó a cabo en posición de semisedestación. Tras la intervención, el paciente refirió clínica compatible con parálisis del nervio hipogloso derecho, iniciada de forma paulatina, que desapareció 4 semanas después. Varios mecanismos se han descrito como causantes de esta alteración neurológica, entre ellos la hiperextensión de la cabeza en el momento de la intubación, la presión ejercida por el neumotaponamiento, o la posición excesivamente hiperextendida o lateralizada de la cabeza durante la cirugía. Se discuten las posibles causas, los factores predisponentes y se sugieren medidas de prevención (AU)
We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in «beach chair» position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures (AU)
Subject(s)
Humans , Male , Apraxias/complications , Apraxias/drug therapy , Hypoglossal Nerve , Hypoglossal Nerve , Hemiarthroplasty/instrumentation , Hemiarthroplasty/methods , Anesthesia, General/instrumentation , Anesthesia, General/methods , Anesthesia, General , Hemiarthroplasty/standards , Hemiarthroplasty , Intubation, Intratracheal/instrumentation , Intubation, Intratracheal/methods , Shoulder/pathology , Shoulder/surgery , ShoulderABSTRACT
We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in "beach chair" position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures.
Subject(s)
Arthroplasty , Hypoglossal Nerve Injuries/etiology , Postoperative Complications/etiology , Shoulder Joint/surgery , Anesthesia, General/adverse effects , Comorbidity , Head Movements , Humans , Hypoglossal Nerve Injuries/prevention & control , Intraoperative Complications/etiology , Intubation, Intratracheal/adverse effects , Male , Middle Aged , Nerve Block , Nerve Compression Syndromes/etiology , Nerve Compression Syndromes/prevention & control , Patient Positioning/adverse effects , Postoperative Complications/prevention & control , Remission, Spontaneous , Ultrasonography, InterventionalABSTRACT
El programa ALFIL, realizado por Socidrogalcohol, es una aproximación preventiva selectiva para hijos de alcohólicos. Consta de dos partes: un análisis de los factores de riesgo específicos y el perfil biopsicosocial de hijos de alcohólicos de 6 a 17 años, y un ensayo de sesiones psicoeducativas grupales. En la fase inicial de este proyecto nos propusimos la elaboración de un protocolo de evaluación de marcadores de riesgo que permitiese la detección precoz de los jóvenes más vulnerables a las consecuencias del alcoholismo familiar. En este artículo se revisan marcadores de riesgo potencialmente útiles para este cometido y se describe la metodología y el protocolo de evaluación utilizados en el estudio.Resultados preliminares del análisis del perfil psicosocial de los hijos de alcohólicos evaluados indican que éstos presentan, frente a los controles, peor ambiente familiar, menor nivel socioeconómico, peor rendimiento cognitivo y escolar, más síntomas de psicopatología y mayor necesidad de asistencia psicológica. Ello justifica la generalización de intervenciones psicoeducativas para este grupo de alto riesgo. Se propone su realización en grupos pequeños, de forma natural, no alarmista y lo más normalizada posible. Se constata la necesidad de optimizar la batería de screening con fines de detección precoz, así como de elaborar estrategias específicas para motivar a participar en programas preventivos a las familias más reacias (AU)
