Electrodiagnos-tic studies like sensory evoked potentials (SEP), electromyography (EMG) and nerve compound action potentials (NCAPs) are performed intraoperatively to aid
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This became progressively jagged with increasing current till diaphragmatic contraction could be palpated by the blinded surgical assistant at about 6-7 mA.Ĭonclusion: Capnography is a sensitive intraoperative test for localizing the phrenic nerve during the supraclavicular approach to the brachial plexus.Įarly surgical intervention after brachial plexus injury is the best predictor of a favourable functional outcome after a trial of conservative management. Results: In all patients, the capnographic wave form revealed a notch at a stimulating amplitude of about 2-4 mA. Both observers were blinded as to when the bipolar stimulating electrode was actually in use. The capnographic wave form was observed by the neuroanesthetist and simultaneous diaphragmatic contraction was assessed by the surgical assistant. The phrenic nerve was identified after blind bipolar electrical stimulation using a handheld bipolar nerve stimulator set at 2-4 mA. Routine monitoring included heart rate, noninvasive blood pressure, pulse oximetry and time capnography. Muscle relaxants were avoided, anaesthesia was induced with propofol and fentanyl and the airway was secured with an appropriate sized laryngeal mask airway. Methods: Three consecutive patients with traction pan-brachial plexus injuries scheduled for neurotization were evaluated under an anesthetic protocol to allow intraoperative electrophysiology.
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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.īackground: To determine whether monitoring end- tidal Carbon Dioxide (capnography) can be used to reliably identify the phrenic nerve during the supraclavicular exploration for brachial plexus injury. This article is available from: © 2008 Bhagat et al licensee BioMed Central Ltd. Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 doi:l0.ll86/l 749-7221-3- Accepted: 14 Hemant Bhagatn, Anil Agarwaln and Manish S Sharma*2Īddress: department of Neuroanesthesia, All India Institute of Medical Sciences, New Delhi-110029, India and 2Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi-110029, IndiaĮmail: Hemant Bhagat - Anil Agarwal - Manish S Sharma* - * Corresponding author tEqual contributors Journal of Brachial Plexus and Peripheral Nerve InjuryĬapnography as an aid in localizing the phrenic nerve in brachial plexus surgery.
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