A Novel Automated Somatosensory Evoked Potential (SSEP) Monitoring Device for Detection of Intraoperative Peripheral Nerve Injury in Cardiac Surgery: A Clinical Feasibility Study.
OBJECTIVE
Peripheral nerve injury (PNI) is a common and potentially devastating complication in cardiac surgery. Somatosensory evoked potential (SSEP) monitoring is one of the modalities for PNI; however, its application is limited by complicated logistics. This study aimed to assess the feasibility of using a novel, automated SSEP device (EPAD; SafeOp Surgical, Hunt Valley, MD) for detection of intraoperative PNI during cardiac surgery.


METHODS
Prospective, observational study.


METHODS
Single university hospital.


METHODS
Cardiac surgical patients.


METHODS
After Ethics Board approval and written consent, study participants were monitored using the EPAD automated SSEP device during cardiac surgery. All patients with prolonged and abnormal SSEP changes were evaluated postoperatively, and if they were symptomatic, they were referred for further nerve conduction and electromyographic assessment.


RESULTS
Of the 43 patients who consented to study inclusion, 33 were monitored successfully. With increasing clinical experience the authors encountered minimal technical issues, and satisfactory signals were obtained in most patients. Abnormal SSEP signal changes, which were encountered in 5 (15.2%) patients, were interpreted as impending PNI; 3 patients experienced prolonged signal changes (>1 h), and 2 (6.1%) of these developed symptomatic peripheral neuropathy that was confirmed with nerve conduction studies.


CONCLUSIONS
The EPAD automated SSEP device is a viable option for detecting PNI during cardiac surgery. A high incidence of intraoperative peripheral nerve compromise and a 6.1% incidence of postoperative peripheral neuropathy were observed. This study reports the clinical feasibility of using the EPAD automated SSEP device; additional studies are required to evaluate the diagnostic test accuracy and the outcome benefit of routine SSEP monitoring in cardiac surgical patients.
Departments of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: Jason.chui@lhsc.on.ca.
Jason
J
Chui
Departments of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
John M
JM
Murkin
Departments of Anesthesia and Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Timothy
T
Turkstra
Department of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.
Neil
N
McKenzie
Department of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.
Linrui
L
Guo
Department of Cardiac Surgery, University of Western Ontario, London, Ontario, Canada.
Mackenzie
M
Quantz
D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005073:Evoked Potentials, Somatosensory / Q000502:physiology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059348:Peripheral Nerve Injuries / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D011446:Prospective Studies
EPAD; cardiac surgery; neuromonitoring; neuropathy; neuropraxia; peripheral nerve injury; positioning; somatosensory evoked potential