However, TTX had little effect on spontaneous synaptic activity. It seems, therefore that functional GABAergic connectivity within the DCN is sparse and/or weak at least under our experimental conditions. Even though present in all cell types, the spontaneous GABAergic events showed significant differences between selleck chemical the cell types. The synaptic currents in GABAergic cells had lower amplitude,
lower frequency and slower kinetics than those of non-GABAergic cells. These differences could not be sufficiently explained by considering only cell size differences or a differential GABA(A)-receptor a-subunit composition. Rather, the main differentiating factor appears to be the dendritic localization of GABAergic synapses in the GABAergic cells. (C) 2008 IBRO. Published by Elsevier Ltd. All rights reserved.”
“Objective: Several reports in the literature have described the value of regional cerebral oximetry (rSO(2)) as a neuromonitoring device during carotid endarterectomy (CEA). The use of rSO(2) is enticing because it is simpler and less expensive than other neuromonitoring modalities. This study was performed to compare the efficacy of rSO, with electroencephalography (EEG) and median nerve somatosensory evoked potentials (SSEP) in determining when to place a shunt during CEA.
Methods. From October
2000 to June 2006, 323 CEAs were performed under general anesthesia by six surgeons. Shunting was done selectively LCL161 oil
the basis of EEG and SSEP monitoring under the auspices of all intraoperative neurophysiologist. All patients were retrospectively reviewed to see if significant discrepancies existed between EEG/ SSEP and Phosphoglycerate kinase rSO(2).
Results: Twenty-four patients (7.4%) showed significant discrepancies. Sixteen patients showed no significant EEG/SSEP changes, but profound changes occurred in rSO(2), and no shunt was placed. In seven patients there was no change in rSO, but a profound change occurred in EEG/SSEP, and shunts were placed. In one patient early in the series, the EEG and SSEP were unchanged but the rSO(2) dropped precipitously, and a shunt was placed. In the 299 patients who showed no discrepancies, 285 were not Shunted and 14 required a shunt. Two strokes occurred in the entire series (0.6%), none intraoperatively. Shunts were placed in 23 patients (7%). The sensitivity of rSO(2) compared with EEG/SSEP was 68%, and the specificity was 94%. This gave a positive-predictive value of 47% and a negative-predictive value of 98%.
Conclusions. Relying oil rSO(2) alone for selective shunting is potentially dangerous and might have led to intraoperative ischemic strokes in seven patients and the unnecessary use of shunts in at least 16 patients in this series. The use of rSO(2) adds nothing to the information already provided by EEG and SSEP in determining when to place a shunt during CEA.