A standard procedure for continuous intraoperative monitoring of the integrity of the corticospinal tracts by eliciting muscle responses is the electric stimulation mapping (ESM). However, standard ESM protocols are ineffective in 20% of young children. We have developed a novel, highly efficient paradigm consisting of short-time burst (30 ms) of high frequency (500 Hz) and high peak current (<=100 mA), which may cause local tissue overheating. The presented safety control study was therefore designed. The infrared thermography camera captured to-be-resected cortex of 13 patients in vivo during ESM. Thermograms were image processed to reveal discrete ESM thermal effect of currents from 10 to 100 mA. Peak 100 mA currents induced a maximal increase in temperature of 3.1 degreeC, 1.23+/-0.72 degreeC in average. The warming correlated with stimulating electrode resistance ( ). The measurement uncertainty was estimated +/- 1.01 C for the most skeptical conditions. The histopathological evaluation of stimulated tissue (performed in all cases) did not show any destructive changes. Our study demonstrates the ability of the thermographic camera to measure the discrete thermal effect of the ESM. The results provide evidence for the safety of the proposed protocol for full range currents with minimal risk of brain tissue damage.

• MeSH
• bezpečnost pacientů MeSH
• dítě MeSH
• elektrická stimulace * MeSH
• infračervené záření MeSH
• kalibrace MeSH
• lidé MeSH
• mapování mozku * metody   MeSH
• mladiství MeSH
• peroperační monitorování * metody   škodlivé účinky   MeSH
• předškolní dítě MeSH
• pyramidové dráhy MeSH
• ruka MeSH
• teplota MeSH
• termografie * metody   škodlivé účinky   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH

BACKGROUND: The use of goal directed fluid protocols in intermediate risk patients undergoing hip or knee replacement was studied in few trials using invasive monitoring. For this reason we have implemented two different fluid management protocols, both based on a novel totally non-invasive arterial pressure monitoring device and compared them to the standard (no-protocol) treatment applied before the transition in our academic institution. METHODS: Three treatment groups were compared in this prospective study: the observational (CONTROL, N = 40) group before adoption of fluid protocols and two randomized groups after the transition to protocol fluid management with the use of the continuous non-invasive blood pressure monitoring (CNAP®) device. In the PRESSURE group (N = 40) standard variables were used for restrictive fluid therapy. Goal directed fluid therapy using pulse pressure variation was used in the GDFT arm (N = 40). The influence on the rate of postoperative complications, on the hospital length of stay and other parameters was assessed. RESULTS: Both protocols were associated with decreased fluid administration and maintained hemodynamic stability. Reduced rate of postoperative infection and organ complications (22 (55 %) vs. 33 (83 %) patients; p = 0.016; relative risk 0.67 (0.49-0.91)) was observed in the GDFT group compared to CONTROL. Lower number of patients receiving transfusion (4 (10 %) in GDFT vs. 17 (43 %) in CONTROL; p = 0.005) might contribute to this observation. No significant differences were observed in other end-points. CONCLUSION: In our study, the use of the fluid protocol based on pulse pressure variation assessed using continuous non-invasive arterial pressure measurement seems to be associated with a reduction in postoperative complications and transfusion needs as compared to standard no-protocol treatment. TRIAL REGISTRATION: ACTRN12612001014842.

• MeSH
• arteriální tlak fyziologie   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• náhrada kyčelního kloubu škodlivé účinky   metody   MeSH
• peroperační monitorování škodlivé účinky   metody   MeSH
• pooperační komplikace diagnóza   etiologie   prevence a kontrola   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• tekutinová terapie metody   MeSH
• totální endoprotéza kolene škodlivé účinky   metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

The 3T ioMRI in Prague is composed of two independent suites: the operating theatre and the 3T MR suite, both of which can and do work independently. They are connected by a double door and a special transportation system. The whole operating table is moved on rails to and from the MR gantry. Anaesthesiological equipment is built from paramagnetic material, which is also moved to and from the MR suite. The integral parts of the multifunctional surgical suite (MFSS) are the neuronavigation system, electrophysiological monitoring, surgical microscope with availability of indocyanin green angiography and fluorescence-guided glioma resection technique and endoscopy equipment. The operating theatre is equipped in a normal fashion with the exception of a head holder that is paramagnetic. MR radiologist and MR assistants are alerted approximately 30 min before the requested intraoperative and out-patient service is interrupted to clean the MR suite. The ioMRI takes 15-20 min and immediately after the door closes the out patient activity is resumed. Intraoperative MR was performed in 332 surgeries in the first 17 months of operation. The most frequent indications were pituitary adenomas, followed by gliomas. Other indications were less frequent and included meningiomas, cavernomas, aneurysms, epilepsy surgery, intramedullary lesions, non-pituitary sellar lesions, metastases and various other surgeries. In 332 cases no technical or medical complication connected with ioMRI was encountered.

• MeSH
• lidé MeSH
• magnetická rezonanční angiografie škodlivé účinky   přístrojové vybavení   metody   MeSH
• magnetická rezonanční tomografie škodlivé účinky   přístrojové vybavení   metody   MeSH
• nemoci mozku chirurgie   MeSH
• peroperační monitorování škodlivé účinky   přístrojové vybavení   metody   MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH