1985
DOI: 10.1055/s-2007-1014177 View full text |Buy / Rent full text
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Abstract: Somatosensory evoked cervical and cortical potentials (SEP) were analyzed under general anesthesia in 106 patients undergoing carotid endarterectomy. Cortical electrical silence occurred in 5 patients without an inlying shunt; all developed a new neurologic deficit postoperatively. Analysis of the SEP in these patients revealed progredient cerebral ischemia as indicated by an increase in central conduction time (CCT) and a decrease in amplitude of the primary cortical response N20P25 resulting in a complete lo… Show more

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“…Proponents of SSEP agree on its feasibility, safety, [46][47][48][49] and high reliability in detecting early neurological changes. Others have claimed that utility of SSEP is not well characterized and is less accurate than other modalities.…”
Section: Spmentioning
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“…Proponents of SSEP agree on its feasibility, safety, [46][47][48][49] and high reliability in detecting early neurological changes. Others have claimed that utility of SSEP is not well characterized and is less accurate than other modalities.…”
Section: Spmentioning
“…The optimal method for evaluating cerebral perfusion during CEA and to determine the need for selective shunting is also controversial. In patients undergoing CEA under general anesthesia, several investigators prefer electroencephalogram (EEG) monitoring, [22][23][24][25][26][27][28][29] while others prefer transcranial Doppler (TCD), [30][31][32][33][34][35] carotid stump pressure (SP) measurements, 14,[36][37][38][39][40][41][42][43][44][45] somatosensory evoked potential (SSEP), [46][47][48][49][50][51][52][53][54][55] or cerebral oximetry monitoring 56,57 to determine the need for shunting. Meanwhile, for patients undergoing CEA with regional anesthesia, selective shunting can be based on alterations in the neurological examination that develop after carotid clamping.…”
mentioning
“…The calculation of recorded shunt parameter, as suggested in previous studies by different groups (amplitude reduction N20/P25 .50% [8], amplitude loss of N20/P25 [6], CCT prolongation .20% [12,13], NSI .0.5 [14]), is shown in Table 2. These parameters were correlated chronologically with the corresponding clinical-neurological examination.…”
Section: Discussionmentioning
“…Amplitude reduction of the N20/ P25-waveform .50% [7,8,10,13] as a marker of critical reduction of cerebral blood flow showed a false-positive indication for shunting in 31 points (34%), whereas 11 cases (13%) of clinically evident reduced CBF were not detected by this parameter. Even the definition of critically reduced CBF after the total loss of N20/ P25 [3,4,6] led to a false alarm in 10 cases and 15 of the clinically relevant CBF-reduction episodes were undetected.…”
Section: Validity Of Ssep-generated Shunt Criteriamentioning
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