Somatosensory evoked potential monitoring during cardiac surgery: An examination of brachial plexus dysfunction

Seal, Douglas; Balaton, John; Coupland, Stuart G.; Eagle, Chris; MacAdams, Charles; Kowalewski, Richard; Bharadwaj, B

doi:10.1016/s1053-0770(97)90212-3

Cited by 16 publications

(3 citation statements)

References 20 publications

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“…Seal et al [13] studied the effect of Pittman Favoloro (used for IMA harvest) and Pittman sternal retractor on ulnar and median nerve SSEPs. Fifteen of twenty patients showed significant SSEP reduction (≥50% reduction from baseline).…”

Section: Resultsmentioning

confidence: 99%

Does retraction of the sternum during median sternotomy result in brachial plexus injuries?

Healey

O'Neill

Bilal³

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does retraction of the sternum during median sternotomy result in brachial plexus injuries or peripheral neuropathies?' Altogether 58 papers were found using the reported search, of which 12 represented the best evidence to answer the question. The authors, date, journal and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Caudal placement of the retractor or relieving the pressure superiorly by removing the upper blades of a retractor (P = 0.02) and use of a caudally placed symmetrical retractor has been shown to reduce neuropathy. Positioning of the patient with 'hands up' positioning showed significant reduction in the incidence of brachial plexus injuries. Furthermore, how wide the retractor is opened and use of an asymmetrical retractor for internal mammary artery (IMA) harvesting are also important factors in quantifying risk of postoperative neuropathy. Wider sternal retraction and longer bypass time did increase the risk of developing postoperative neuropathy. Three asymmetrical retractors were looked at that demonstrates the Delacroix-Chevalier to be the safest (P < 0.05). We conclude that median sternotomy risks brachial plexus injury and where possible the sternum should be opened as small a distance as possible with symmetrical retractor and using a caudally placed retractor.

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Section: Resultsmentioning

confidence: 99%

Does retraction of the sternum during median sternotomy result in brachial plexus injuries?

Healey

O'Neill

Bilal³

et al. 2013

Interactive CardioVascular and Thoracic Surgery

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“…Other iatrogenic complications affecting the brachial plexus, identified in up to 37% of patients [9]. There are many hypotheses for why this may be the case.…”

Section: Objectivesmentioning

confidence: 99%

“…There are many hypotheses for why this may be the case. One of the most recognized causes is the use of the sternal retractor which, most likely, would cause a stretching of the ischemia to the plexus [9,10].…”

Section: Objectivesmentioning

confidence: 99%

The Five Diaphragms in Patients Following Cardiac Surgery in Sternotomy: An Observational Study

Bordoni¹

2017

IJCAM

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The recovery and rehabilitation process of patients following heart surgery in sternotomy is lengthy and requires significant time. This observational study on five diaphragms in patients undergoing a sternotomy is the first of its kind.Objectives: Evaluate the position of the 5 bodily diaphragms, creating a platform of useful information for the practice of manual therapy. Understand if the diaphragm position coincides with the clinical status of the patient.Setting: Department for Cardiac Rehabilitation, Foundation Don Carlo Gnocchi IRCCS. Materials and methods:From January 2012 to July 2016, 300 cardiac patients underwent evaluation following a cardiothoracic intervention. In a supine position, palpation was conducted on the pelvic floor, the respiratory diaphragm, the thoracic outlet, the buccal floor and the cerebellar tentorium. The evaluation was undertaken on the first day of recovery in the ward. Rating scales were conducted such as the VAS, the walking test and the air life, an instrument for measuring the volume of air inhaled.Results: Eleven different positional organisation structures of the 5 diaphragms have been highlighted which do not correspond to the patient's clinical status. Conclusions:The data collected from the study allows us to obtain important information to guide the work of the manual therapist, but does not have a direct relationship with the patient's functional status.

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Intraoperative Brain Monitoring in Cardiac Surgery

Arrowsmith

Ganugapenta²

2010

Brain Protection in Cardiac Surgery

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Somatosensory evoked potential monitoring during cardiac surgery: An examination of brachial plexus dysfunction

Cited by 16 publications

References 20 publications

Does retraction of the sternum during median sternotomy result in brachial plexus injuries?

Does retraction of the sternum during median sternotomy result in brachial plexus injuries?

The Five Diaphragms in Patients Following Cardiac Surgery in Sternotomy: An Observational Study

Intraoperative Brain Monitoring in Cardiac Surgery

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