caa a22 4500 606214623 CHVBK 20210128101054.0 cr unu---uuuuu 210128e20151201xx s 000 0 eng 10.1007/s00701-015-2603-5 doi (NATIONALLICENCE)springer-10.1007/s00701-015-2603-5 Ventilator waveforms on anesthesia machine: A simple tool for intraoperative mapping of phrenic nerve and mid-cervical roots [Elektronische Daten] [George Georgoulis, Eirini Papagrigoriou, Marc Sindou] Background: A crucial aspect of surgery on the supraclavicular region, lateral neck, and mid-cervical vertebral region is the identification and sparing of the phrenic nerve and cervical (C4) root that are responsible for diaphragmatic innervation. Therefore intraoperative mapping of these nerve structures can be useful for difficult cases. Electrical stimulation with simultaneous observation of the ventilator waveforms of the anesthesia machine provides an effective method for the precise intraoperative mapping of these structures. In the literature, there is only one publication reporting the use of one of the waveforms (capnography) for this purpose. Methods: Capnography and pressure-time waveforms, two mandatory curves in anesthesiological monitoring, were studied under electrical stimulation of the phrenic nerve (one patient) and the C4 root (eight patients). The aim was to detect changes that would verify diaphragmatic contraction. No modifications in anesthesia or surgery and no additional maneuvers were required. Results: In all patients, stimulation was followed by identifiable changes in the two waveforms, compatible with diaphragmatic contraction: acute reduction in amplitude on capnography and repetitive saw-like elevations on pressure-time curve. Frequency of patterns on pressure-time curve coincided with the frequency of stimulation; therefore the two recordings were complementary. Conclusions: This simple method proved effective in identifying the neural structures responsible for diaphragmatic function. We therefore suggest that it should be employed in the various types of surgery where these structures are at risk. Springer-Verlag Wien, 2015 Electrical stimulation nationallicence Intraoperative mapping nationallicence Cervical roots nationallicence Phrenic nerve nationallicence Anesthesia machine waveforms nationallicence Diaphragm monitoring nationallicence Georgoulis George 1st Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, GHE University of Lyon1, 59 Bvd Pinel, 69500, Lyon-Bron, France aut Papagrigoriou Eirini Intensive Care Unit, "Agios Panteleimon” General Hospital of Nikaia - Peiraeus, Peiraeus, Greece aut Sindou Marc University of Lyon 1, Lyon, France aut Acta Neurochirurgica Springer Vienna 157/12(2015-12-01), 2169-2173 0001-6268 157:12<2169 2015 157 701 https://doi.org/10.1007/s00701-015-2603-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-015-2603-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Georgoulis George 1st Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, GHE University of Lyon1, 59 Bvd Pinel, 69500, Lyon-Bron, France aut NATIONALLICENCE 700 1- Papagrigoriou Eirini Intensive Care Unit, "Agios Panteleimon” General Hospital of Nikaia - Peiraeus, Peiraeus, Greece aut NATIONALLICENCE 700 1- Sindou Marc University of Lyon 1, Lyon, France aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/12(2015-12-01), 2169-2173 0001-6268 157:12<2169 2015 157 701