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Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children

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Abstract

Bulbocavernosus reflex (BCR) monitoring is used to assess the integrity of urinary and bowel function. In this study, we evaluated the feasibility of BCR monitoring during untethering surgery in infants and children to predict postoperative urinary and bowel dysfunction. The records of 22 patients ranging from 4 days to 10 years old (mean 2.7 ± 3.3 years) were reviewed. Anesthesia was maintained by propofol or sevoflurane/opioid without neuromuscular blockade. BCR waveforms induced by electrical stimulation (20–40 mA, train-of-four pulses with 500 Hz) to the penis or clitoris were recorded from bilateral external anal sphincters. To assess the sensitivity and specificity of BCR monitoring, we investigated the association between a significant continuous decrease in BCR amplitude at the end of surgery and postoperative urinary and bowel dysfunction after surgery. Reproducible baseline BCR waveforms were successfully recorded in 20 of 22 patients (90.9%). A significant continuous decrease in BCR amplitude was observed in 8 patients. The results of intraoperative BCR monitoring included three true-positives, twelve true-negatives, five false-positives, and zero false-negatives. Therefore, the sensitivity and specificity of BCR monitoring used to predict postoperative urinary and bowel dysfunction were 100 and 70.6%, respectively. BCR monitoring during untethering surgery in infants and children under general anesthesia was found to be a feasible method to prevent postoperative urinary and bowel dysfunction.

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Authors and Affiliations

  1. Department of Anesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Takeaki Shinjo, Hironobu Hayashi & Masahiko Kawaguchi

  2. The Central Clinical Laboratory, Nara Medical University Hospital, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Tsunenori Takatani

  3. Department of Neurosurgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Eishu Boku & Hiroyuki Nakase

Authors
  1. Takeaki Shinjo
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  2. Hironobu Hayashi
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  3. Tsunenori Takatani
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  4. Eishu Boku
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  5. Hiroyuki Nakase
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  6. Masahiko Kawaguchi
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Correspondence to Hironobu Hayashi.

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Shinjo, T., Hayashi, H., Takatani, T. et al. Intraoperative feasibility of bulbocavernosus reflex monitoring during untethering surgery in infants and children. J Clin Monit Comput 33, 155–163 (2019). https://doi.org/10.1007/s10877-018-0127-2

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  • DOI: https://doi.org/10.1007/s10877-018-0127-2

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