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| Content Provider | World Health Organization (WHO)-Global Index Medicus |
|---|---|
| Author | Kamel, Ihab Zhao, Huaqing Koch, Stephen A. Brister, Neil Barnette, Rodger E. |
| Description | Author Affiliation: Kamel I ( From the Department of Anesthesiology, Temple University School of Medicine, Philadelphia, Pennsylvania.) |
| Abstract | BACKGROUND: Peripheral nerve injury is a significant perioperative problem. Intraoperative position-related neurapraxia may indicate impending peripheral nerve injury and can be detected by changes in somatosensory evoked potentials (SSEP). The purpose of this retrospective analysis of spine surgeries performed under general anesthesia with SSEP monitoring was to determine the relationship between intraoperative mean arterial blood pressure (MAP) and intraoperative upper extremity position-related neurapraxia in the prone surrender (superman) position. METHODS: We reviewed a computerized database of spine surgeries performed on adult patients in the prone surrender position. The authors reviewed intraoperative SSEP monitoring reports to identify the patients who developed intraoperative upper extremity position-related neurapraxia (case group) and patients who did not (control group). Propensity matching was performed to derive 2 demographically matched groups. Preoperative and intraoperative variables were included in the univariate Cox regression analysis of risk factors associated with neurapraxia. Multivariate Cox regression models were used to identify the independent risk factors. RESULTS: One hundred fifty-two patients were included in the analysis. The case group included 32 patients, whereas the control group included 120 matched patients. Intraoperative MAP <55 mm Hg for a total duration of ≥5 minutes was an independent risk factor associated with a greater incidence of upper extremity position-related neurapraxia compared with a duration of <5 minutes with MAP <55 mm Hg (hazard ratio, 3.43; confidence interval, 1.445-8.148; P = 0.0052). Intraoperative MAP >80 mm Hg for a total duration of >55 minutes was an independent predictor associated with a lower incidence of neurapraxia compared with a total duration ≤55 minutes (hazard ratio, 0.341; confidence interval, 0.163-0.717; P = 0.0045). CONCLUSIONS: In this study, we identified the changes in intraoperative MAP as independent predictors associated with upper extremity position-related neurapraxia in the prone surrender position under general anesthesia. |
| File Format | HTM / HTML |
| ISSN | 00032999 |
| Issue Number | 5 |
| Volume Number | 122 |
| e-ISSN | 15267598 |
| Journal | Anesthesia & Analgesia |
| Language | English |
| Publisher | Lippincott Williams & Wilkins |
| Publisher Date | 2016-05-01 |
| Publisher Place | United States |
| Access Restriction | One Nation One Subscription (ONOS) |
| Subject Keyword | Discipline Anesthesiology Arterial Pressure Evoked Potentials, Somatosensory Intraoperative Neurophysiological Monitoring Methods Orthopedic Procedures Adverse Effects Patient Positioning Peripheral Nerve Injuries Etiology Prone Position Spine Surgery Upper Extremity Innervation Adult Aged Anesthesia, General Chi-square Distribution Databases, Factual Female Humans Kaplan-meier Estimate Male Middle Aged Multivariate Analysis Diagnosis Physiopathology Prevention & Control Predictive Value Of Tests Propensity Score Proportional Hazards Models Retrospective Studies Risk Assessment Risk Factors Time Factors Journal Article |
| Content Type | Text |
| Resource Type | Article |
| Subject | Anesthesiology and Pain Medicine |
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