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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two elderly females with Rett syndrome are reported with evidence of a slowly progressive central and distal peripheral nervous system involvement. Thermography in 4 girls confirmed distal hypothermia of the extremities in a glove and stocking distribution. Unilateral sympathectomy during surgery for scoliosis in one of them resulted in increased warmth and physical growth of the foot and nails, compared to the uninjured side. This suggests increased sympathetic tone as the probable cause of distal hypothermia, vasomotor instability and dystrophy of the feet in this disorder. In an attempt to identify a marker, girls with clinically classical Rett syndrome had plasma and urinary cell evaluation for an unusual glycolipid. A blind study using a small number of patients failed to prove absolute specificity and additional studies are required to evaluate its validity as a marker for Rett syndrome.
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PMID:Rett syndrome: new observations. 282 48

Systemic effects such as anesthesia, hypotension, hypothermia, and hypoxia affect the cortical evoked responses. We propose, that by sequential stimulation of the median and posterior tibial nerves, and the construction of a ratio from the value of their amplitudes, the systemic effects can be eliminated and thus improve the reliability of the cortical evoked responses. Two groups of scoliosis patients who underwent spinal surgery with instrumentation were analyzed retrospectively. Both groups had spinal cord monitoring using peripheral nerve stimulation and cortical recordings of the somatosensory-evoked response (SER). In Group I, 50 patients were analyzed for changes in posterior tibial nerve response before and after distraction. Wide variability in the response suggested this method to be less reliable in predicting spinal cord conduction deficits. Thirty-eight patients in Group 2 were analyzed using both the median and posterior tibial nerve amplitudes. A ratio of the posterior tibial to median nerve wave amplitude was constructed, thus eliminating any systemic variables. A critical value, alerting the surgeons to possible decreases in spinal cord conduction, was calculated by subtracting one standard deviation from the mean of the postdistraction ratios of the posterior tibial to median nerves (1.20-.633 = .567).
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PMID:A new technique to improve cortical-evoked potentials in spinal cord monitoring. A ratio method of analysis. 361 45

Scoliosis surgery in the adolescent is prolonged, painful and haemorrhagic. There are neurological risks and surveillance of the medulla is necessary throughout surgery. An anterior (Dwyer, Zielke) or posterior (Harrington, Cotrel-Dubousset, Luque) approach to the spinal column cas used. Surgery using a posterior approach is the more haemorrhagic. The haemorrhage is increased by poor positioning of the patient, by the duration of surgery and by taking the bone graft. Constant care should be given to blood economy, using controlled hypotension, haemodilution and peroperative autotransfusion of lost blood (Cell-Saver). The anaesthetic should provide excellent analgesic effects and must be compatible with regain of consciousness during surgery and/or or the use of evoked potential techniques. Complications at that time are those of the circulation and those of neurological origin and linked with hypothermia. In the presence of haemorrhage, the maintenance of total blood volume is difficult when there is cardiopathy (myopathy). Neurological complications should be detected sufficiently early for them to be reversible (sensori-motor evoked potentials and/or "wake-up test"). Hypothermia is constant and requires the systematic use of a heated mattress, a heated humidifier and the heating of infusions. The postoperative complications are respiratory in origin and are especially associated with neuro-muscular disease (postoperative artificial ventilation). The per- and postoperative difficulties demonstrate the importance of the preoperative examination and of the preparation of the operation (respiratory preparation). Finally, staged autotransfusion should be used, when possible, and should be part of the techniques of blood economy in a true transfusion strategy.
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PMID:[Anesthetic problems and postoperative care in the surgery for scoliosis]. 781 11

Paraplegia caused by irreversible lesions of the spinal cord is one of the major possible complications after scoliosis surgery. Several monitoring methods have been proposed but none are completely satisfactory. Since 1986 the authors assessed motor pathways during scoliosis surgery, using electrical stimulation of the motor cortex and lower limb muscle recordings (tibialis anterior muscle). Twenty-seven patients were included in this study: 25 with idiopathic scoliosis and 2 with dorsal kyphosis. Recordings in anesthetized patients with hypothermia were performed before and after spinal derotation during the surgical procedure. Magnetic cortical stimulation was carried out in ten awake patients before and after surgery. Reproducible responses were obtained in 22 patients under anesthesia. In eight patients no difference of the latency of the muscle response was detected before and after the correction of the spinal angulation. In 14 patients the increase of latency ranged from 0.4 ms to 5.2 ms. No correlation was found between the slowing of motor conduction and the magnitude of spine correction. No central neurologic complications were seen after surgery. The authors concluded that their study demonstrated that motor pathway assessment in anesthetized patients can be performed at different times during the surgical procedure. This technique should help in the future monitoring spinal function during scoliosis surgery.
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PMID:Monitoring of the motor pathway during spinal surgery. 848 44

The aim of specific monitoring in neuroanaesthesia is to detect, as quickly as possible, intraoperative ischaemic insults so that the brain and the spinal cord may be protected from harmful and frequently inevitable events due to the type of surgery, patient positioning, haemodynamic changes or any intercurrent event. New monitors are being introduced into the operating theatre, but only a few are considered to be an absolute standard of care in neurosurgery, e.g. facial nerve monitoring for surgery of acoustic neuromas and recording of evoked potentials during repair of scoliosis. In the past decade, new monitoring devices have moved from the experimental stage to the operating theatre and although most are still in a phase of technological development and/or definition of their field of applicability they are being used as guides for clinical practice in those instances where cerebral well-being might be impaired. The metabolic consequences of hyperventilation, pharmacological electroencephalogram burst suppression, hypothermia, etc. can now be assessed in the operating theatre. Non-invasive monitoring is being rapidly integrated into our daily work because of its lack of secondary effects. Nevertheless, each new development is regarded as an addition rather than as a substitute for existing equipment. The perfect combination of monitors to provide essential information during an individual surgical procedure to influence a better patient outcome, is still uncertain and needs extensive clinical research.
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PMID:Monitoring in neuroanaesthesia: update of clinical usefulness. 1209 21

In scoliosis surgery, intraoperative somatosensory evoked potential (SSEP) monitoring has reduced the incidence of postoperative neurologic deficits. Many factors affect the amplitude and latency of SSEP waveforms during surgery. Somatosensory evoked potential amplitude decreases with ischemia and anoxia because of temporal dispersion of the afferent volley and conduction block in damaged axons. In conjunction with surgical manipulations, minor drops in blood pressure may result in substantial SSEP changes that reverse when perfusion pressure is increased. Irreversible anoxic injury to central nervous system white matter with loss of SSEP waveforms is dependent on calcium influx into the intracellular space. Somatosensory evoked potential monitoring may be less sensitive for detecting acute insults in the presence of preexisting white matter lesions. Increased extracellular potassium from acute baro-trauma can block axonal conduction transiently even when there is no axonal disruption. Marked temperature-related drops in SSEP amplitude may occur after exposure of the spine but before instrumentation and deformity correction. Hypothermia may increase false-negative outcomes. Short-interval double-pulse stimulation may improve the sensitivity of the SSEP in detecting early ischemic changes. For neurosurgical procedures on the spinal cord the use of SSEP monitoring in improving postoperative outcome is less well established.
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PMID:Mechanisms of signal change during intraoperative somatosensory evoked potential monitoring of the spinal cord. 1247 86

Spinal column deformity is associated with potentially serious alterations of respiratory and cardiac function. Such alterations, in association with the underlying disease that caused the deformity--such as neuromuscular disease--are risk factors that affect the prognosis for scoliosis patients undergoing anesthesia and surgery. It is important for the anesthesiologist to carry out a detailed preoperative assessment to identify patients at risk with the aim of decreasing morbidity and mortality related to surgical correction of deformities. Of paramount importance is awareness of the risk of injury to the spinal cord that will affect function. Other issues are how to manage the patient in anomalous positions, the risk associated with hypothermia secondary to exposure of a large surgical field for a long period, and bleeding, which can sometimes exceed the patient's total volume. In the case of scoliosis surgery, all those situations may converge, obliging us to provide careful intraoperative monitoring, particularly of spinal function; to choose the appropriate anesthetic technique; and to maintain vigilance during the early postoperative period to foresee possible complications. Because scoliosis surgery is multidisciplinary, several teams must work together to assure success.
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PMID:[Anesthesia for scoliosis surgery: preoperative assessment and risk screening of patients undergoing surgery to correct spinal deformity]. 1574 3

Vivian Ebsary was an inventor, designer and manufacturer of varied pieces of medical equipment, particularly those involving pumps. These included hypothermia machines and the heart-lung cardiopulmonary bypass machines used in Australian and New Zealand hospitals from the mid 1950s until well into the 1970s. Ebsary also designed and manufactured anaesthetic machines, a hyperbaric unit, scoliosis implant equipment, a chairlift and many other devices for use in the general community. This paper presents an overview of his life's involvement with medicine and medical technology in Australia.
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PMID:Vivian Richard Ebsary, A.M. biomedical engineer, inventor, philanthropist. 1601 35

Somatosensory evoked potential (SEP) has been widely used for monitoring the abnormal nerve conduction in various diseases. In non-anesthetized patients, Abeta fibers are electrically stimulated during SEP measurements. In anesthesiological field, it is used as a short latency somatosensory potential (SSEP), because its latency and amplitude are relatively constant. To detect the conduction abnormality from the upper extremities to the brain, median nerve stimulation is used. For the detection of spinal cord abnormality during operation, posterior tibial nerve stimulation is often used. It is important to know the origin of the wave appearing in SSEP to find the lesion in the nervous system. SSEP has been used in scoliosis surgery, carotid endarterectomy, thoracoabodominal aortic surgery and cervical operations to detect brain and spinal ischemia. In an intensive care unit, it is used for the diagnosis of brain death or ischemia and other neuronal diseases such as Guillain-Barre syndrome and polyneuritis etc. In pain clinic, laser evoked potential (LEP) has been recently introduced for the analysis of the mechanisms of nerve and spinal cord diseases. Using the LEP, pain mechanism would be clarified. During SSEP measurements, it is necessary for the anesthesiologists, intensivists and pain clinicians to understand the effect of anesthetic drugs and hypothermia on SSEP.
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PMID:[Somatosensory evoked potential]. 1654 77

Patients undergoing surgical correction of scoliosis present many challenges to anesthetists because of the pathophysiologic derangements caused by the disease and the demanding nature of the anesthetic care that is required. A thorough understanding of the pathophysiology of the disease, intraoperative concerns specific to the procedure, and the efficacy of various anesthetic management techniques is required by anesthetists to optimally care for patients undergoing surgical correction of scoliosis. This literature review focuses on key considerations for anesthetists, including common comorbidities in patients with scoliosis, the need for induced hypotension, large surgical blood loss, the need for transfusion of blood and blood products, possible autologous blood donation and acute normovolemic hemodilution, patient positioning, possible intraoperative wake-up testing to assess motor function, spinal cord monitoring, and hypothermia.
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PMID:Anesthetic implications for surgical correction of scoliosis. 1771 Nov 58


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