Startle sign events induced by mechanical manipulation during surgery for neuroma localization: a retrospective cohort study.

Autor: Gorky JM; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA., Karinja SJ; Division of Plastic and Reconstructive Surgery, The Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Ranjeva SL; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA., Liu L; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA., Smith MR; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA., Mueller AL; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA., Houle TT; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA., Eberlin KR; Division of Plastic and Reconstructive Surgery, The Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA., Ruscic KJ; Department of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA. kruscic@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: BMC anesthesiology [BMC Anesthesiol] 2024 Oct 18; Vol. 24 (1), pp. 376. Date of Electronic Publication: 2024 Oct 18.
DOI: 10.1186/s12871-024-02758-5
Abstrakt: Background: Chronic pain from peripheral neuromas is difficult to manage and often requires surgical excision, though intraoperative identification of neuromas can be challenging due to anatomical ambiguity. Mechanical manipulation of the neuroma during surgery can elicit a characteristic "startle sign", which can help guide surgical management. However, it is unknown how anesthetic management affects detection of the startle sign.
Methods: We performed a retrospective cohort study of 73 neuroma excision surgeries performed recently at Massachusetts General Hospital. Physiological changes in the anesthetic record were analyzed to identify associations with a startle sign event. Anesthesia type and doses of pharmacological agents were analyzed between startle sign and no-startle sign groups.
Results: Of the 64 neuroma resection surgeries included, 13 had a startle sign. Combined intravenous and inhalation anesthesia (CIVIA) was more frequently used in the startle sign group vs. no-startle sign group (54% vs. 8%), while regional blockade with monitored anesthetic care was not associated with the startle sign group (12% vs. 0%), p = 0.001 for anesthesia type. Other factors, such as neuromuscular blocking agents, ketamine infusion, remifentanil infusion, and intravenous morphine equivalents showed no differences between groups.
Conclusions: Here, we identified hypothesis-generating descriptive differences in anesthetic management associated with the detection of the neuroma startle sign during neuroma excision surgery, suggesting ways to deliver anesthesia facilitating detection of this phenomenon. Prospective trials are needed to further validate the hypotheses generated.
(© 2024. The Author(s).)
Databáze: MEDLINE
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