Intraoperative monitoring with somatosensory evoked potentials in carotid artery surgery--less reliable in patients with preoperative neurologic deficiency?

Acta Anaesthesiologica Scandinavica
U LinstedtA Petry

Abstract

In a retrospective analysis of intraoperative somatosensory evoked potential (SEP) results during carotid artery surgery we found some cases with postoperative neurologic deficits, surprisingly without significant SEP changes. Median nerve SEP were monitored as usual. Indication for selective shunting was a complete loss of amplitude N20/P25 in the first period of the investigation, later on a 50% reduction, or a prolongation of the central conduction time (CCT) of about 1.5 ms after cross-clamping. Anaesthesia was maintained with isoflurane in N2O/O2, fentanyl and atracurium. Over a 3-year period 146 patients were monitored. Indications were: transient ischaemic attacks (TIA) (n=51), stroke (n=23), stroke with residuals (n=39), asymptomatical stenosis (n=29), subclavian steal syndrome (n=4). Twenty-four patients received an intraluminal shunt following SEP alterations. Postoperatively, 5 patients (3.4%) had symptoms of intraoperative brain ischaemia (stroke n=2, TIA n=3), 4 of them showing only minor intraoperative SEP alterations; 1 received a shunt because of CCT prolongation. Four of these 5 patients had cerebral neurologic deficiency preoperatively. Since some authors have found a 100% sensitivity of intraoperative SEP, it...Continue Reading

References

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Citations

Mar 20, 2004·Neurophysiologie clinique = Clinical neurophysiology·Geneviève FlorenceBernard Gueguen
Dec 4, 2012·Clinical Neurophysiology : Official Journal of the International Federation of Clinical Neurophysiology·M J MalcharekV Deletis
Sep 13, 2011·Journal of Vascular Surgery·Ali F AburahmaPatrick A Stone
Nov 5, 2004·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Pirjo ManninenMital Joshi
Sep 8, 2018·Journal of Neurosurgery·Sumito OkuyamaKazuo Watanabe
Sep 21, 2004·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·David W RowedAmanda B Taylor

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