Startle sign events induced by mechanical manipulation during surgery for neuroma localization: a retrospective cohort study.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Jonathan M Gorky, Sarah J Karinja, Sylvia L Ranjeva, Lingshan Liu, Matthew R Smith, Ariel L Mueller, Timothy T Houle, Kyle R Eberlin, Katarina J Ruscic
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引用次数: 0

Abstract

Background: Chronic pain from peripheral neuromas is difficult to manage and often requires surgical excision, though intraoperative identification of neuromas can be challenging due to anatomical ambiguity. Mechanical manipulation of the neuroma during surgery can elicit a characteristic "startle sign", which can help guide surgical management. However, it is unknown how anesthetic management affects detection of the startle sign.

Methods: We performed a retrospective cohort study of 73 neuroma excision surgeries performed recently at Massachusetts General Hospital. Physiological changes in the anesthetic record were analyzed to identify associations with a startle sign event. Anesthesia type and doses of pharmacological agents were analyzed between startle sign and no-startle sign groups.

Results: Of the 64 neuroma resection surgeries included, 13 had a startle sign. Combined intravenous and inhalation anesthesia (CIVIA) was more frequently used in the startle sign group vs. no-startle sign group (54% vs. 8%), while regional blockade with monitored anesthetic care was not associated with the startle sign group (12% vs. 0%), p = 0.001 for anesthesia type. Other factors, such as neuromuscular blocking agents, ketamine infusion, remifentanil infusion, and intravenous morphine equivalents showed no differences between groups.

Conclusions: Here, we identified hypothesis-generating descriptive differences in anesthetic management associated with the detection of the neuroma startle sign during neuroma excision surgery, suggesting ways to deliver anesthesia facilitating detection of this phenomenon. Prospective trials are needed to further validate the hypotheses generated.

神经瘤定位手术中机械操作诱发的惊跳征事件:一项回顾性队列研究。
背景:外周神经瘤引起的慢性疼痛难以控制,通常需要手术切除,但由于解剖学上的模糊性,术中识别神经瘤可能具有挑战性。手术期间对神经瘤的机械操作可引起特征性的 "惊跳征",这有助于指导手术治疗。然而,麻醉管理如何影响惊跳征的检测尚不得而知:我们对最近在麻省总医院进行的 73 例神经瘤切除手术进行了回顾性队列研究。我们分析了麻醉记录中的生理变化,以确定与惊跳征事件的关联。分析了惊跳征组和无惊跳征组的麻醉类型和药剂剂量:结果:在64例神经瘤切除手术中,13例出现了惊跳征。与无惊跳征组相比,惊跳征组更常使用静脉和吸入联合麻醉(CIVIA)(54% 对 8%),而区域阻滞与麻醉监测护理与惊跳征组无关(12% 对 0%),麻醉类型的 p = 0.001。其他因素,如神经肌肉阻滞剂、氯胺酮输注、瑞芬太尼输注和静脉注射吗啡当量在组间没有差异:在此,我们发现了与神经瘤切除手术中发现神经瘤惊跳征相关的麻醉管理差异,并提出了有助于发现这一现象的麻醉方法。需要进行前瞻性试验来进一步验证所提出的假设。
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来源期刊
BMC Anesthesiology
BMC Anesthesiology ANESTHESIOLOGY-
CiteScore
3.50
自引率
4.50%
发文量
349
审稿时长
>12 weeks
期刊介绍: BMC Anesthesiology is an open access, peer-reviewed journal that considers articles on all aspects of anesthesiology, critical care, perioperative care and pain management, including clinical and experimental research into anesthetic mechanisms, administration and efficacy, technology and monitoring, and associated economic issues.
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