| Transcranial Doppler ultrasonography as a screening technique for detection of a patent foramen ovale before surgery in the sitting position. | |
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MedLine Citation:
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PMID: 11020748 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Venous air embolism has been reported to occur in 23-45% of patients undergoing neurosurgical procedures in the sitting position. If venous air embolism occurs, a patent foramen ovale (PFO) is a risk factor for paradoxical air embolism and its sequelae. Preoperative screening for a PFO is therefore recommended by some investigators. The reference standard for identifying a PFO is contrast-enhanced transesophageal echocardiography (c-TEE). Contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) are noninvasive alternative methods, but so far there are no studies as to their diagnostic validity in neurosurgical patients. METHODS: The sensitivity and specificity of c-TCD and c-TTE in detecting a PFO were determined in a prospective study using c-TEE as the reference standard. Preoperative c-TCD, c-TTE, and c-TEE studies were performed during the Valsalva maneuver after intravenous echo-contrast medium (D-Galactose, Echovist-300, Schering AG, Berlin, Germany) was administered in 92 consecutive candidates (47 men and 45 women; mean age, 51 yr; range, 25-72 yr) before neurosurgical procedures in the sitting position. RESULTS: A PFO was detected in 24 of the 92 patients (26.0%) using c-TEE. c-TCD correctly identified 22 patients, whereas c-TTE only correctly identified 10. This corresponds to a sensitivity of 0.92 for c-TCD and 0.42 for c-TTE. The negative predictive value was 0.97 for c-TCD compared with 0.83 for c-TTE. The prevalence of a PFO in patients with a posterior fossa lesion was 27%, and in the group with cervical disc herniation was 24% as detected by c-TEE. The incidence of intraoperative venous air embolism was 35% in cases of cervical foraminotomy and 75% in posterior fossa surgery as detected by c-TEE. CONCLUSIONS: c-TCD is a highly sensitive and highly specific method for detecting a PFO. Because c-TCD is noninvasive, it may be more suitable than c-TEE for routine preoperative screening for a PFO. C-TTE is not reliable in detecting a PFO. |
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Authors:
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R Stendel; H J Gramm; K Schröder; C Lober; M Brock |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article |
Journal Detail:
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Title: Anesthesiology Volume: 93 ISSN: 0003-3022 ISO Abbreviation: Anesthesiology Publication Date: 2000 Oct |
Date Detail:
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Created Date: 2000-10-13 Completed Date: 2000-10-27 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 1300217 Medline TA: Anesthesiology Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 971-5 Citation Subset: AIM; IM |
Affiliation:
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Departments of Neurosurgery, Anesthesiology and Critical Care Medicine, and Cardiology and Pulmonology, Benjamin Franklin Medical Center, Freie Universität Berlin, Berlin, Germany. stendel@medizin.fuberlin.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Contrast Media / therapeutic use Echocardiography, Transesophageal / methods Embolism, Air / etiology Embolism, Paradoxical / etiology Female Heart Septal Defects, Atrial / complications, ultrasonography* Humans Male Middle Aged Neurosurgical Procedures / adverse effects, methods* Posture / physiology Predictive Value of Tests Preoperative Care Prospective Studies Sensitivity and Specificity Ultrasonography, Doppler, Transcranial / methods* |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media |
| Comments/Corrections | |
Comment In:
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Anesthesiology. 2001 Sep;95(3):808-9
[PMID:
11575563
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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