Author/Editor		Rodi, Zoran
Title		Medoperativni elektrofiziološki nadzor bulbokavernoznega refleksa pri bolnikih s poškodbo prsno-ledvene hrbtenice
Type		monografija
Place		Ljubljana
Publisher		Medicinska fakulteta
Publication year		1998
Volume		str. 93
Language		slo
Abstract		This study attempted to evaluate the method of intraoperative neurophysiological monitoring of the bulbocavernosus reflex with reference to stimulation and recording, to describe the behaviour of bulbocavernosus reflex responses in anaesthetized patients, and to analyze quantitatively the influence of the anaesthetic agents used. Finally, the clinical usefulness of the method is evaluated. A group of 53 patients, 40 men and 13 women, with fractures of thoracolumbar vertebrae was studied. Patients underwent spinal surgery with pedicle screws and internal fixation. There were no signs of lesion of the sacral nervous system prior to or following surgery, which was proved clinically in men and electrophysiologically in women. Intraoperatively, the dorsal nerve of the penis or the clitoris was electrically stimulated to elicit reflex responses in the external anal sphincter. For stimulation, standard superf cial cup electrodes were placed on the dorsum of the penis or the clitoris. For detection, intramuscular wire electrodes were introduced into the perianal area. Anaesthesia was induced by bolus injections of propofol (a phenol sedative), fentanyl (an opioid analgesic), and vecuronium bromide (a short-acting muscle relaxant). Thereafter, a continuous infusion of propofol and fentanyl was used for maintenance of anaesthesia. Intraoperative bulbocavernosus reflex responses were detected in 93 % of men and in 23 % of women. The low rate of elicitability in women was most probably due to inefficient stimulation, the reasons being unfavourable anatomical conditions and poor electrode-skin contact. In men, inadequate detection was most probably due to insertion of the tips of the wire electrodes through the muscle into conective tissue. (Abstract truncated at 2000 characters).
Descriptors		SPINAL INJURIES INTRAOPERATIVE PERIOD REFLEX LUMBOSACRAL PLEXUS THORACIC VERTEBRAE LUMBAR VERTEBRAE ELECTRIC STIMULATION PENIS CLITORIS PROPOFOL FENTANYL VECURONIUM BROMIDE ANUS