Skinner Stanley, Chiri Chala A, Wroblewski Jill, Transfeldt Ensor E
Minneapolis Neuroscience Institute, 800 East 28th Street, Minneapolis, MN 55407-3799, USA.
J Clin Monit Comput. 2007 Feb;21(1):31-40. doi: 10.1007/s10877-006-9055-7. Epub 2006 Dec 1.
Electrophysiological bulbocavernosus reflex (BCR) testing, during surgeries in which the constituent neural components are at risk, might supplement other low sacral (S2-4) stimulation/recording techniques. However, intraoperative BCR is not always reliably implemented. We proposed to analyze BCR signals in five surgical patients monitored with the novel application of double train stimulation (DTS) to determine if the potential could be enhanced.
We prospectively planned a regime of DTS BCR with a series of intertrain delays in five monitored patients at risk for low sacral neural injury. Patients were maintained with propofol, opiate infusion, and low inhalant anesthesia without muscle relaxant. Cutaneous sensory nerves of the penis (or clitoris) were stimulated using two consecutive pulse trains (DTS). Intertrain delays were 75, 100, 125, 150, 175, 200, and 250 ms. For BCR recording, uncoated paired wires were inserted into the external anal sphincter (EAS) bilaterally. For each trial, waveform amplitude, duration, and turn count measures for the first (single train) and second (double train) response were recorded. Percent increase/decrease of the second train response compared to the first train response was calculated.
There was at least a 30% increase in measures of amplitude, turn count, and duration of the second train response in 22/28, 22/28, and 14/28 of the total trials respectively. There was an insufficient number of independent observations to determine statistical significance.
Intraoperative BCR is currently obtained with some difficulty using pulse train stimulation. Our preliminary evidence has identified BCR waveform enhancement using DTS and suggests that the reliability of intraoperative BCR acquisition may be further improved by the addition of this technique. Our data are insufficient to define the best intertrain interval.
在构成神经成分有风险的手术过程中，电生理球海绵体反射（BCR）测试可能会补充其他低骶段（S2 - 4）刺激/记录技术。然而，术中BCR并非总能可靠实施。我们提议分析五名接受手术患者中采用双脉冲串刺激（DTS）新应用监测的BCR信号，以确定其潜力是否能得到增强。
我们前瞻性地规划了一项针对五名有低骶神经损伤风险且接受监测的患者的DTS BCR方案，其中包含一系列脉冲串间延迟。患者通过丙泊酚、阿片类药物输注和低浓度吸入麻醉维持，不使用肌肉松弛剂。使用两个连续的脉冲串（DTS）刺激阴茎（或阴蒂）的皮肤感觉神经。脉冲串间延迟为75、100、125、150、175、200和250毫秒。为记录BCR，将未涂覆的配对导线双侧插入肛门外括约肌（EAS）。对于每次试验，记录第一个（单脉冲串）和第二个（双脉冲串）反应的波形幅度、持续时间和转折计数测量值。计算第二个脉冲串反应相对于第一个脉冲串反应的增加/减少百分比。
在总试验中，第二个脉冲串反应的幅度、转折计数和持续时间测量值分别在22/28、22/28和14/28中至少增加了30%。独立观察数量不足，无法确定统计学意义。
目前使用脉冲串刺激术中获取BCR存在一定困难。我们的初步证据已确定使用DTS可增强BCR波形，并表明添加该技术可能会进一步提高术中BCR采集的可靠性。我们的数据不足以确定最佳脉冲串间隔。
