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  • Book
    Christoph N. Seubert, Jeffrey R. Balzer, editors.
    Summary: As a single-source volume on intraoperative neurophysiological monitoring (IOM), previous editions of this celebrated resource amounted to a mission statement from the pioneer generation in intraoperative neurophysiology, converting insights, techniques, and perspectives into tools providing clinical utility for the assessment of the nervous system in patients who could not be assessed by a standard neurological examination. Now directed by a new generation of experts, this thoroughly illustrated Third Edition is updated with new case material, images, videos, practice guidelines, references, and technologies, and is intended for those who encounter IOM in the operating room and intensive care unit, including anesthesiologists, technologists, neurophysiologists, surgeons, and nurses, as well as graduate students and trainees. Offering topical, applicable information, this accessible reference and teaching tool provides practical knowledge to help students, trainees, and team members better understand one anothers roles, thereby improving patient safety and care.

    Contents:
    Intro
    Preface
    Acknowledgments
    Contents
    Contributors
    Part I: Monitoring Techniques
    1: Somatosensory-Evoked Potentials
    Introduction
    Anatomy and Vascular Supply
    Methods
    Stimulation
    Recording
    Intraoperative Variables Affecting SSEPS: Pharmacology and Physiology
    Inhalational Anesthetics
    Intravenous Anesthetics
    Temperature
    Tissue Perfusion
    Oxygenation/Ventilation
    Intracranial Pressure
    Other Physiologic Variables
    Criteria for Intervention During Intraoperative SSEP Monitoring
    Dorsal Column Mapping Other Intraoperative Applications for SSEPs
    References
    2: Transcranial Motor-Evoked Potentials
    Introduction
    Anatomy of the MEP Response
    Technical Aspects of MEP Monitoring
    Optimizing Compound Muscle Action Potential
    Patient Characteristics Contributing to Outcomes
    Effect of Anesthesia Management
    Outcomes
    Conclusion
    References
    3: Auditory-Evoked Potentials
    Anatomy of the Auditory System
    Conduction of Auditory Signals from Ear to Cochlea
    Neural Components of the Auditory System and Electrical Generators Along the Auditory Pathway References
    4: Visual-Evoked Potentials
    Introduction
    Flash Electroretinogram (F-ERG)
    Flash Visual-Evoked Potentials (F-VEPs)
    Introduction of the Intraoperative Monitoring of the Visual System: Orbital Surgeries
    Identified Sources of Intraoperative Variations in F-VEPs
    Recognition of a Reliable Monitoring of Vision
    Anatomy and Physiology of the Visual System
    Realization of Intraoperative Electroretinogram (ERG) and Flash Visual-Evoked Potentials (F-VEPs)
    Intraoperative ERG
    Intraoperative F-VEP
    Devices for Flash Stimulation
    Characteristics of Stimulation Light Cochlea: Electrocochleogram
    Auditory Pathway from Cochlear Nerve to Midbrain
    Auditory Brainstem-Evoked Responses and Cochlear Nerve Compound Action Potential
    Primary Auditory Cortex: Mid-Latency Auditory-Evoked Potentials
    Vascular Supply of Auditory Pathway Structures
    Techniques for Recording Auditory-Evoked Potentials
    Stimulation
    Electrocochleogram
    Compound Nerve Action Potentials from the Cochlear Nerve
    Brainstem Auditory-Evoked Potentials
    MLAEPs
    Anesthetic and Physiologic Considerations for Monitoring of Auditory Brainstem Responses
    ABR Alarm Criteria ERG Recordings and Analyses
    F-VEP Recordings and Analyses
    Warning Criteria
    Warning Criteria for ERGs
    Warning Criteria for F-VEPs
    Other Intraoperative Applications with ERG and F-VEP: Cardiovascular Surgeries, Deep Brain Stimulation
    Direct Electrical Stimulation of Visual Pathway
    Effects of Temperature
    Effects of Anesthesia on ERGs
    Effects of Anesthesia on F-VEPs
    Conclusion
    References
    5: Deep Brain Stimulation
    Introduction
    Surgery
    Microelectrode Recording (MER)
    Complications
    Asleep vs. Awake Surgery
    The MER Procedure
    Digital Access Springer 2023
  • Article
    Spicher G, Peters J.
    Zentralbl Bakteriol B. 1978 Aug;167(1-2):63-82.
    The method described by SPICHER and PETERS (1975) for the calculation and description of the resistance of microbiological indicators was tested. As test objects served spore-containing earth according to DIN 58946, Attest indicators (3 M Company, Minnesota) and Oxoid Spore Strips (Oxoid Ltd., London). The tests were performed not only for different batches of indicators but also for preparations of different age. After application of steam (120 degrees C), the indicators were examined for the presence of surviving germs capable of multiplication. When plotting the frequency of indicators with surviving germs (q) against the duration of steam action, S-shaped curves were obtained as expected. By altering the scale of the ordinate (y = lg (-ln(1 - q))), the S-shaped curves could be transformed into straight lines. Thus, the experimentally established paired values could be used for a calculation of regression. This method of calculation proved to be suitable in all cases studied. By indicating the position and the slope of these straight regression lines, the resistance of microbiological indicators can be exactly described (cf. Table 2). This method is applicable not only to indicators containing culture spores but also for native spore-containing earth. The indicators examined differed in their resistance and stability. Seven out of eight batches of Attest indicators (cf Figs. 1 and 2 and Table 1) fulfilled the requirements of DIN 58946, Part 4, for the resistance of bio-indicators for steam sterilization. One of the batches had a slightly higher resistance. The Attest indicators tested were of good stability (see Fig. 1 and Table 1). Where surviving germs were present on the indicators after treatment by steam, their growth was recognizable, in 99% of cases, already after incubation of the cultures for 24 hours. Only two batches of Oxoid Spore Strips were available for testing. One batch was of a higher resistance than required by DIN 58946. The second batch was slightly above the lower limit of the permissible range (see Fig. 3). During storage for 12 months, the resistance of both batches was reduced by 3--4 min. Where the indicators exhibited surviving germs after treatment by steam, growth was recognizable in 87% of the cases after incubation for 24 hours, while for the other indicators, incubation for 48 hours was necessary. The experiments confirmed the good stability of native spore-containing earth (see Fig. 5). Within 4--5 years, the steam resistance of the preparations decreased only by 3--4 min.
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