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European Journal of Anaesthesiology.... 2008Weakness of the limbs and respiratory muscles has increasingly been found to be a frequent event that complicates the medical history of patients in Intensive Care. The... (Review)
Review
Weakness of the limbs and respiratory muscles has increasingly been found to be a frequent event that complicates the medical history of patients in Intensive Care. The problem normally affects more serious cases and presents as muscular weakness leading to flaccid paralysis and difficulty in weaning patients off mechanical ventilation. This latter sign leads the intensivist to suspect possible involvement of the neuromuscular respiratory system. Unfortunately, in-depth clinical assessment of the neuromuscular respiratory system is difficult with critically ill patients, and electrophysiological studies have been used instead to overcome this problem. Of these latter, electric and electromagnetic stimulation of the phrenic nerve have been successful (along with needle electromyography of the diaphragm) in identifying the causes of neuromuscular respiratory insufficiency, especially in Intensive Care. In this brief chapter, we will be discussing the technique of electric stimulation of the phrenic nerve and neuromuscular respiratory insufficiency within the field of critical illness polyneuropathy.
Topics: Critical Care; Electric Stimulation; Electromagnetic Phenomena; Electromyography; Electrophysiology; Humans; Nervous System Diseases; Neuromuscular Diseases; Phrenic Nerve; Polyneuropathies; Respiration, Artificial; Respiratory Insufficiency; Time Factors; Treatment Outcome; Ventilator Weaning
PubMed: 18289440
DOI: 10.1017/S0265021507003377 -
Anesthesiology Jul 2017Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that... (Review)
Review
Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.
Topics: Anesthesia, Conduction; Humans; Paralysis; Phrenic Nerve; Shoulder
PubMed: 28514241
DOI: 10.1097/ALN.0000000000001668 -
Pulmonology 2019The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation,... (Comparative Study)
Comparative Study Review
The diaphragm is the main breathing muscle and contraction of the diaphragm is vital for ventilation so any disease that interferes with diaphragmatic innervation, contractile muscle function, or mechanical coupling to the chest wall can cause diaphragm dysfunction. Diaphragm dysfunction is associated with dyspnoea, intolerance to exercise, sleep disturbances, hypersomnia, with a potential impact on survival. Diagnosis of diaphragm dysfunction is based on static and dynamic imaging tests (especially ultrasound) and pulmonary function and phrenic nerve stimulation tests. Treatment will depend on the symptoms and causes of the disease. The management of diaphragm dysfunction may include observation in asymptomatic patients with unilateral dysfunction, surgery (i.e., plication of the diaphragm), placement of a diaphragmatic pacemaker or invasive and/or non-invasive mechanical ventilation in symptomatic patients with bilateral paralysis of the diaphragm. This type of patient should be treated in experienced centres. This review aims to provide an overview of the problem, with special emphasis on the diseases that cause diaphragmatic dysfunction and the diagnostic and therapeutic procedures most commonly employed in clinical practice. The ultimate goal is to establish a standard of care for diaphragmatic dysfunction.
Topics: Diaphragm; Diaphragmatic Eventration; Fluoroscopy; Humans; Microsurgery; Phrenic Nerve; Radiography; Respiration, Artificial; Respiratory Function Tests; Respiratory Paralysis; Transcutaneous Electric Nerve Stimulation; Ultrasonography
PubMed: 30509855
DOI: 10.1016/j.pulmoe.2018.10.008 -
Journal of Cancer Research and... Dec 2022This study aimed to analyze the cases of phrenic nerve injury caused by the percutaneous microwave ablation of lung tumors conducted at our center and to explore the...
OBJECTIVE
This study aimed to analyze the cases of phrenic nerve injury caused by the percutaneous microwave ablation of lung tumors conducted at our center and to explore the risk factors.
MATERIALS AND METHODS
The data of 455 patients who underwent the percutaneous microwave ablation of lung tumors at the Department of Interventional Radiology, First Affiliated Hospital of Fujian Medical University from July 2017 to October 2021, were retrospectively analyzed. The cases of phrenic nerve injury after the percutaneous ablation were reported to analyze the risk factors involved, such as the shortest distance between tumor margin and phrenic nerve, tumor size, and ablation energy. The groups were divided based on the shortest distance between the tumor edge and the phrenic nerve into group 1, d ≤ l cm; group 2, 1 < d ≤2 cm; and group 3, d >2 cm. Lesions with a distance ≤2 cm were compared in terms of tumor size and ablation energy.
RESULTS
Among the 455 patients included in this study, 348 had primary lung cancer, and 107 had oligometastatic cancer. A total of 579 lesions were detected, with maximum diameter of 1.27 ± 0.55 cm, and the ablation energy was 9,000 (4,800-72,000) J. Six patients developed phrenic nerve injury, with an incidence of 1.32%. For these six patients, the shortest distance from the lesion edge to the phrenic nerve was 0.75 ± 0.48 cm, and the ablation energy was 10,500 (8,400-34,650) J. There were statistically significant differences in phrenic nerve injury among groups 1, 2, and 3 (P < 0.05). In patients with a distance (d) ≤ 2 cm, there were no significant differences in tumor diameter and energy between the phrenic nerve injury group and the non-injury group (P = 0.80; P = 0.41). In five out of six patients, the diaphragm level completely recovered to the pre-procedure state, and the recovery time of the phrenic nerve was 9.60 ± 5.60 months. Another one was re-examined 11 months after the procedure, and the level of the diaphragm on the affected side had partially recovered.
CONCLUSIONS
Phrenic nerve injury is a rare but not negligible complication of thermal ablation and is more likely to occur in lesions with a distance ≤2 cm from the phrenic nerve.
Topics: Humans; Catheter Ablation; Phrenic Nerve; Retrospective Studies; Microwaves; Lung Neoplasms; Treatment Outcome
PubMed: 36647962
DOI: 10.4103/jcrt.jcrt_1254_22 -
Neurology India 2022To report a new patient friendly and convenient technique for phrenic nerve conduction with alternative sites of stimulation and recording.
OBJECTIVE
To report a new patient friendly and convenient technique for phrenic nerve conduction with alternative sites of stimulation and recording.
METHODS
Phrenic nerve conduction was performed in forty volunteers and ten patients of peripheral neuropathy. Active recording electrode was placed in tenth intercostal space 2.5 cm away from para-spinal muscles (mid-scapular line), reference electrode in eighth intercostal space just medial to subcostal margin with ground between stimulating and recording electrode. Stimulation was done at the level of crico-thyroid space near or under the posterior margin of sternocleidomastoid muscle. This new method was compared with existing ones.
ANALYSIS
Data was analysed using SPSS 23 version. Correlation between height, weight, body mass index, age, and chest expansion was done using bi-variate correlation. Mean latency and amplitude of the study method were compared with other methods using MANNOVA test.
RESULTS
Total of forty subjects were studied. Thirty-seven were male subjects. Mean age was 28.03 ± 9.63 years, height 168.0 ± 9.60 cm and chest expansion 3.53 ± 0.64 cm. Right sided phrenic nerve mean latency was 5.99 ± 0.629 ms and amplitude 1.088 ± 0.178 mV. Left sided phrenic nerve conductions showed mean latency of 6.02 ± 1.82 ms, amplitude of 1.092 ± 0.2912 mV. These standard deviations were smaller than what were observed with other methods suggesting increased consistency of our results. There was no correlation between phrenic nerve conduction with age, height, gender or chest expansion.
CONCLUSION
This study method gave a better as well as consistent morphology, higher amplitude and required lower amount of current strength. It was superior to previously reported methods in consistency of normative data.
Topics: Adolescent; Adult; Female; Humans; Male; Young Adult; Action Potentials; Back; Electrodes; Electromyography; Neck; Neural Conduction; Neurologic Examination; Peripheral Nervous System Diseases; Phrenic Nerve
PubMed: 36412357
DOI: 10.4103/0028-3886.360904 -
Minerva Anestesiologica Dec 2023
Topics: Humans; Phrenic Nerve; Paralysis; Peripheral Nervous System Diseases
PubMed: 37534885
DOI: 10.23736/S0375-9393.23.17595-X -
The Annals of Thoracic Surgery Mar 1986
Topics: Cardiac Surgical Procedures; Humans; Phrenic Nerve
PubMed: 3954514
DOI: 10.1016/s0003-4975(10)62797-x -
Surgical and Radiologic Anatomy : SRA Feb 2019Variations of the phrenic nerve gain importance in the context of subclavian vein cannulation, implanted venous access portals and supraclavicular nerve block for...
PURPOSE
Variations of the phrenic nerve gain importance in the context of subclavian vein cannulation, implanted venous access portals and supraclavicular nerve block for regional anaesthesia. Some of the variations of phrenic nerve are very common and may have implications even while performing very simple and routine procedures.
METHODS
During routine dissection in the Department of Anatomy, an anatomical variation was observed in the course of the phrenic nerve in an adult male cadaver.
RESULTS
On the right side, phrenic nerve in its early course in the neck, close to its origin was giving a communicating branch to the upper trunk of the brachial plexus. Further course of the phrenic nerve was typical. On the left side, no such communication between phrenic nerve and brachial plexus was observed.
CONCLUSIONS
A thorough knowledge of the anatomical variations and standard anatomy of phrenic nerve is a necessity for the safe and efficient practice of regional anaesthesia.
Topics: Anatomic Variation; Cadaver; Humans; Male; Middle Aged; Neck; Phrenic Nerve
PubMed: 30361840
DOI: 10.1007/s00276-018-2123-0 -
Journal of Interventional Cardiac... Oct 2014In cardiac resynchronization therapy (CRT), the electrical impulse delivered by the left ventricular (LV) lead may incidentally cause phrenic nerve stimulation (PNS).... (Review)
Review
In cardiac resynchronization therapy (CRT), the electrical impulse delivered by the left ventricular (LV) lead may incidentally cause phrenic nerve stimulation (PNS). The purpose of this state-of-the-art review is to describe the frequency, risk factors, and clinical consequences of PNS and to present the most recent options to successfully manage PNS. PNS occurs in 2 to 37% of implanted patients and is not always detected in the supine position during implantation. Lateral and posterior veins are at higher risk of PNS than anterior veins, and apical positions are at higher risk of PNS than basal positions. The management of PNS discovered during implantation may include mapping the course of the target vein in order to find a PNS-free site, targeting another vein if available, and pacing with alternative configurations before changing the lead location. Non-invasive options for management of post-operative PNS depend on the difference between PNS and LV stimulation thresholds and include reducing the LV pacing output, automatic determination of LV stimulation threshold and minimal output delivery by the device, increasing the pulse duration, and electronic repositioning. New quadripolar leads allow to pace from different cathodes, and the multiple pacing configurations available have proved superior to bipolar leads in mitigating PNS. This electronic repositioning addresses almost all of the clinically relevant PNS and should markedly reduce the need for invasive lead repositioning or CRT abandon, which is actually the last option for 2% of patients.
Topics: Cardiac Resynchronization Therapy; Humans; Phrenic Nerve; Risk Factors
PubMed: 24934757
DOI: 10.1007/s10840-014-9917-8 -
Clinical Anatomy (New York, N.Y.) Nov 2017The accessory phrenic nerve (APN) is a common anatomical variant with differing reports of prevalence in the literature. It can be injured during operative procedures to... (Meta-Analysis)
Meta-Analysis Review
The accessory phrenic nerve (APN) is a common anatomical variant with differing reports of prevalence in the literature. It can be injured during operative procedures to the neck and thorax or by regional anesthetic techniques in its vicinity. Our aim was to provide a comprehensive evidence-based assessment of the prevalence and origins of the APN. The databases PubMed, China National Knowledge Infrastructure, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science were searched comprehensively, followed by assessment of eligibility and extraction of data concerning the APN. The data were pooled into a meta-analysis. A total of 17 studies were included in the meta-analysis. Fourteen studies (n = 1,941 hemi-necks) reported data on APN prevalence resulting in an overall pooled prevalence estimate of 36.5%. Nine studies (n = 941 APNs) reported data on the origin of the APN. Most commonly the APN originated from the ansa cervicalis (16.5%) followed by the nerve to the subclavius (15.8%). Subgroup analysis on the basis of laterality and geographic region revealed no statistically significant findings. The APN is a highly variable anatomical structure present in over one third of the population, most often originating from the ansa cervicalis or the nerve to the subclavius. Clinicians need to be aware of the varying constellation of symptoms that can arise from APN injury. Ultimately, knowledge of APN variation could provide for better outcomes and reduction of iatrogenic injuries, particularly in high-risk patients prone to long-term complications from diaphragmatic dysfunction. Clin. Anat. 30:1077-1082, 2017. © 2017 Wiley Periodicals, Inc.
Topics: Cadaver; Humans; Phrenic Nerve
PubMed: 28726261
DOI: 10.1002/ca.22956