| Intraoperative measurement of pharynx/esophagus retraction during anterior cervical surgery. Part I: pressure. | |
| | |
MedLine Citation:
|
PMID: 16477448 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Temporary dysphagia after anterior cervical discectomy (ACD) is common. However, its mechanism is poorly understood. Pressure induced by retractor blades onto pharynx/esophagus were measured intraoperatively in order to gain more information regarding traumatization of the pharynx/esophagus wall. Thirty-one patients underwent anterior cervical discectomy and fusion (ACDF) for degenerative disc disease. An online pressure transducer was applied to the rear side of the medial retractor blade (epi-esophageal-pressure, epi-P) and a cylindric, inflatable transducer was preoperatively inserted into the pharynx/esophagus under fluoroscopic guidance at the level to be operated on (endo-esophageal-pressure, endo-P). Pressure values were recorded continuously during the operation. Mean arterial pressure (MAP) and endotracheal cuff pressure (ETCP) were recorded additionally. An in vitro model was developed in order to analyze the impact of the retractor blade design onto the epi-esophageal-pressure. Mean epi-P before and following adequate retractor opening for exposure of the disc space was 58.3 and 92.7 mmHg. Thirty, 60 and 90 min later the epi-P decreased to 79, 70 and 66%, respectively. Mean basal endo-P was 9.8 mmHg and increased to 20.6 mmHg after retractor placement. Thirty, 60 and 90 min later the endo-P decreased to 80, 71 and 62%, respectively. The mean MAP was 76 mmHg and the ECTP was adjusted to 25 mmHg during the procedures. In the in vitro model retraction pressure correlated inversely with the contact area between visceral wall and retractor blade. During ACDF the retraction pressure onto the pharyngeal/esophageal wall exceeds MAP and even more the mucosal perfusion pressure of 25 mmHg. Over time the pharynx/esophageal wall adapts to the applied pressure induced by the retractor blade. The contact area between them influences the retraction pressure. |
| | |
Authors:
|
Oliver Heese; Frank Schröder; Manfred Westphal; Luca Papavero |
Related Documents
:
|
1449608 - Pressure profile along the oesophagus during eructation in sheep. 9840058 - Gerd revisited: advances in pathogenesis. 6745028 - Is abdominal compression a useful stimulation test for analysis of lower esophageal sph... 17965058 - Rectal compliance and rectal sensation in constipated adolescents, recovered adolescent... 11195868 - Wound closure by dermatotraction after fasciotomy for acute compartment syndrome. 9205508 - An investigation into the effect of ischaemia and pressure on irritant inflammation. |
Publication Detail:
|
Type: Journal Article Date: 2006-02-14 |
Journal Detail:
|
Title: European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society Volume: 15 ISSN: 0940-6719 ISO Abbreviation: Eur Spine J Publication Date: 2006 Dec |
Date Detail:
|
Created Date: 2006-12-04 Completed Date: 2007-03-19 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9301980 Medline TA: Eur Spine J Country: Germany |
Other Details:
|
Languages: eng Pagination: 1833-7 Citation Subset: IM |
Affiliation:
|
University Hospital Hamburg-Eppendorf, Hamburg, Germany. heese@uke.uni-hamburg.de |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Cervical Vertebrae / surgery* Deglutition Disorders / etiology* Diskectomy / adverse effects*, instrumentation, methods Esophagus / injuries*, surgery Female Humans Male Manometry / instrumentation, methods Middle Aged Monitoring, Intraoperative / instrumentation, methods Pharynx / injuries*, surgery Postoperative Complications / etiology Pressure Prospective Studies Spinal Fusion / adverse effects, instrumentation, methods Surgical Instruments / adverse effects |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Intraoperative measurement of pharynx/esophagus retraction during anterior cervical surgery. Part II...
Next Document: Variability of spinal instrumentation configurations in adolescent idiopathic scoliosis.