Transient Facial Palsy in Sphenoidal Electrode Placement

Summary: Purpose: Sphenoidal electrode (SE) insertion can cause pain, for which local anesthesia with lidocaine or intravenous administration of fentanyl has been advocated by different epilepsy treatment centers. Transient facial palsies have been observed after SE insertion. Their frequency of occurrence, distribution, and duration have not been well characterized, however. We hypothesized that this complication is due to the effect of local anesthesia on the peripheral branches of the seventh cranial nerve. To test this hypothesis, we compared the incidence and characteristics of facial palsy during SE insertions performed with either local anesthesia or after intravenous fentanyl administration.
Methods: We performed a retrospective study in two patient groups. Group A consisted of 25 patients aged 28 ± 8·2 years who underwent a prolonged video-EEG (VEEG) monitoring study with SE after subcutaneous infusion of 1% lidocaine in the insertion area. Group B included 25 patients aged 30·1 ± 8·9 years whose SE were inserted after intravenous administration of 100-200 μ fentanyl. Blood pressure (BP) was monitored every 3-5 min throughout the procedure.
Results: Five patients (20%) from group A had a transient facial palsy; in 4, it was complete and in 1 it was partial; 1 patient had a bilateral facial palsy. Paresis lasted 1-7 min (mean 3·2 min). In all patients, the recovery was complete. None of the patients in group B had complications (p = 0·025, Fisher's exact test).
Conclusions: Transient facial palsy is a relatively frequent complication of SE insertion when SE are placed under local anesthesia; patients should be forewarned of its possible occurrence.     

Bidirectional transvenous/subcutaneous defibrillation of ventricular fibrillation in dogs: success rates, energy requirements, currents, voltages and impedance

Four hundred and thirteen defibrillations of alternating current-inducedventricular fibrillation were performed in 10 halothane-anaesthetizeddogs (body weight: 24.5–30.5 kg). Success rates, energydemands, currents, peak voltages and impedance were determined.A transvenous catheter electrode system (Medtronic 6880, rightventricular apex and superior vena cava, distance 100 or 150mm) and subcutaneous patch electrodes (Intec 67 L, 2nd/3rd and/or3rd/4th left intercostal space) were used for bidirectionaldefibrillation. Loading voltages ranged from 600 to 850 V. Withan electrode distance of 100 mm and a pulse duration of 2 msseparated by 1 ms, success rates were 100%, 40% and 0% for 850,650 and 600 V, respectively. With a 3-ms pulse duration, thecorresponding rates were 100%, 60% and 50%. With a 2-ms pulseduration, successful defibrillation was achieved with energieslower than 15 J in 27%, with energies between 15 and 20 J in77%, and 100% with energies higher than 20 J. Defibrillationcurrents were 4.4–9.3 A for pulse 1 (superior vena cava/ventricularapex) and 6.3–13.4 A for pulse 2 (patch/ventricular apex),respectively. Effective peak voltages ranged from 510 to 787V and from 514 to 777 V and averaged 89.6% of the loading voltages.Impedance values (peak voltage/current) were 75.5–117.7(pulse 1) and 51.7–94.9 Ohms (pulse 2). Fifty consecutivedefibrillations in one animal resulted in a decrease of impedance(114.6 to 84.9 Ohms, pulse 1; 75.4 to 53.0 Ohms, pulse 2). Defibrillationof ventricular fibrillation can be achieved with acceptablylow energies using a bidirectional transvenous/subcutaneoussystem, avoiding thoracotomy and general anaesthesia for implantationof the defibrillation system.     

Conduction studies in peripheral cat nerve using implanted electrodes: III. The effects of prolonged constriction on the distal nerve segment

Electrophysiological properties were monitored in detail in chronically constricted peripheral nerves by implanted, multicontact nerve cuff electrodes and correlated with morphometric histology in selected cases. The physiological and histological responses in nerve to a range of constricting cuffs of standard sizes were readily graded. The initial response to any significant constriction was a transient, focal conduction slowing or block at the constriction, followed by more protracted distal effects; the latter ranged from loss of excitability consistent with "dying-back" degeneration to reductions in conduction velocity consistent with histologically observed atrophy. Smaller myelinated fibers tended to have similar but less pronounced changes than larger diameter fibers. Recordings from ventral and dorsal roots showed that distal degeneration was more pronounced in motor than in sensory fibers of similar caliber. Electronmicroscopical measurements showed that basal laminas were relatively preserved around even the most atrophic and demyelinated axons. Perimeter measurements of the basal lamina could be used to estimate the diameter of the original nerve fiber.     

Properties of implanted electrodes for functional electrical stimulation

Implanted wire electrodes are increasingly being used for the functional electrical stimulation of muscles in partially paralysed patients, yet many of their basic characteristics are poorly understood. In this study we investigated the selectivity, recruitment characteristics and range of control of several types of electrode in triceps surae and plantaris muscles of anaesthetized cats. We found that nerve cuffs are more efficient and selective (i.e., cause less stimulus spread to surrounding muscles) than intramuscular electrodes. Bipolar intramuscular stimulation was more efficient and selective than monopolar stimulation, but only if the nerve entry point was between the electrodes. Monopolar electrodes are efficient and selective if located close to the nerve entry point, but their performance declines with distance from it. Nonetheless, for a variety of reasons monopolar stimulation provides the best compromise in many current applications. Short duration pulses offer the best efficiency (least charge per pulse to elicit force) but high peak currents, increasing the risk of electrode corrosion and tissue damage. Electrode size has little effect on recruitment and should therefore be maximised because this minimises current density.     

Accuracy and choice of procedures in 24-hour oesophageal pH monitoring with monocrystalline antimony electrodes

In 24 h pH monitoring, the evaluation is dependent on the absolute accuracy of the pH measurements. Several sources of error exist, such as the chemical composition of calibration buffers and reference electrode gel and the effect of temperature on both the pH and the reference electrodes. We investigated the magnitude of these errors for the monocrystalline antimony electrode. Similar analysis applies to other types of pH electrodes. The errors we found are important when choosing a calibration procedure. We recommend a calibration procedure in which the pH and reference electrodes are both put in a beaker with the calibration buffers prior to and after the 24 h measurements. The calibration buffers and the electrode gel should have a specially selected ion composition where, for example, the Cl-ion concentration is critical. Corrections for differences in temperature between the calibration and the in situ measurements must be added. The pH measurements can be checked by performing in situ calibration.     

Noise characteristics of stainless-steel surface electrodes

Bioelectric events measured with surface electrodes are subject to noise components which may be significant in comparison with low-level biological signals such as evoked neuroelectric potentials, and myoelectric potentials. In an effort to better understand noise arising from these electrodes, electrode and measurement system noise is modelled. The effect of electrode surface area on electrode impedance and noise is studied using circular stainless-steel electrodes of varying diameters. The main contributions of the work are the development of a model for stainless-steel electrode noise as a function of electrode area, and demonstrating that, for the band-width of interest to evoked neuroelectric and myoelectric signals (8–10 000 Hz), the primary noise components are thermal and amplifier current generated. The magnitudes of both of these depend on the electrode impedance magnitude. Electrode impedance is shown to be a power function of both electrode diameter and frequency, consistent with a capacitive electrode model.     

An Investigation into the Electrical Ablation Technique and a Method of Electrode Assessment

Ablative techniques, using standard defibrillators and commonly available cardiac catheters, have been applied to the His bundle and bypass tracts for the management of arrhythmias. We have done in vitro studies of the physical effects of these high energy electrical impulses delivered via different pacing electrodes. Unipolar impulses of 10 to 400 joules were delivered via three U.S.C.I. bipolar electrodes and three Vitatron Helifix electrodes immersed in Ringer's solution. The effects were recorded on 35 mm still film, video tape, and high speed cine film. Pressure, voltage, and current were measured. The U.S.C.I. bipolar electrodes and the Vitatron Helifix electrodes safely withstood repeated delivery of 400-joule impulses which produced similar flash shapes. Each took the form of an incandescent, spherical "fire-ball" centered around the exposed electrode surface. The mean diameters of the "fire-ball" for 10 to 400 J using the U.S.C.I. electrodes were 5-24 mm and 3-20 mm for the Helifix catheter electrodes. Peak pressure excursions of over an atmosphere were observed 3 cm from the electrode tips. Higher pressures, lower voltages, and larger currents occurred using the U.S.C.I. pacing lead. The simple, 35 mm time exposure technique showed that at low energies the flashes appeared to emerge in a retrograde manner from the U.S.C.I. catheters and more distally from the Helifix electrode. This suggested that the latter might be more effective with lower energy impulses. It is concluded that lower energies should be used to take full advantage of the active fixation electrode.     

Polarisation impendance of pacemaker electrodes:in vitro studies simulating practical operation

The electrical properties of pacemaker electrodes were studiedin vitro under conditions prevailing in practical pacemaker operation. Emphasis was laid on a clear distinction between the changing modes of the pacemaker action. During sensing, the electrode can be represented by an a.c. series polarisation resistance and capacitance, generally accepted for biological electrodes obeying linearity rules. During stimulation, the electrode operates in the non-linear region. A nearly constant-voltage, short, rectangular pulse applied directly to the electrode-heart system, causes the electrode voltage and current to respond as a transient exponential, characterised approximately by a single time constant. This response allows modelling of the d.c. equivalent circuit of the electrode, in the form of a polarisation capacitance with a small resistance in series, shunted by a parallel resistance. Formulae were derived for calculation of these elements. The response of the electrode-heart system to a single stimulus was tested as a function of the amplitude and duration of the applied pulse. Also, the effect of repetitive stimulations was checked at a normal pacing rate. A nearly constant-voltage pacing source, as compared with a constant-current one, appears to be advantageous for preservation of the longevity of the electrode.     

盆腔手术前后血清电解质变化的动态观察

为了解盆腔手术前后血清电解质变化及其规律,于盆腔手术前２４－４８ｈ及术后４８－７２ｈ分别抽取静脉血,用离子选择电极法测定血清钾,钠,氯的水平,用全自动生化分析仪检测血浆钙离子浓度。     

Ischaemia induced alternans of action potential duration in the intact-heart: dependence on coronary flow, preload and cycle length

Clinical and experimental evidence relate action potential duration(APD) alternans to ischaemic heart disease and ventricular arrhythmias.The present investigation was performed to study the quantitativerelationship between APD alternans and the degree ofischaemia,loading conditions and cycle length (CL) in an intact heart. Monophasic action potentials (MAP) were simultaneously recordedby contact electrodes from two left (LV) undone right ventricular(RV) sites in 20 Langendorff-perfused rabbit hearts. The preparationswere subjected to global ischaemia at flow rates ranging from40% of normal flow to complete cessation of flow. Pacing wasperformed at either constant or regularly changing CL. The magnitudeof APD alternans was expressed as beat-to-beat differences inaction potential duration of two consecutive MAPs. During normalper fusion, neither very fast pacing at a CL of 200 ms nor periodicalrate switches resulted in persistent APD alternans. Pacing ata constant CL of 800 ms did not induce A PD alternans at completecessation of flow for 6 min. However, alternans developed progressivelyat a constant CL of 400 ms after 2.8±0.3 min of completeischaemia at the pre-loaded LV, andafter 4.6±0.4 minat the unloaded RV (P<0.01). The reduction of preload atthe LV from 15 to 5 mmftg end-diastolic pressure delayed developmentof APD alternans from 2.8±0.3 min to 4.3±0.4 min(P < 0.05) at 400 ms CL. Following graded under per fusionof 40%, 20% and 10% of initial flow, persistent APD alternansdeveloped in relation to the degree of flow reduction and increasedprogressively with duration ofischaemia. APD alternans at theLV always preceded the onset of APD alternans at the RV. Inexperiments with identical flow rates the shortest CL of 200ms resulted in the greatest and earliest initiation of APD alternanscompared to the longer CL (P<0.01, P<0.001). An increasein CL from 400 to 800 ms immediately abolished APD alternans,generated by the shorter CL, at any time during the 6 min periodof complete ischaemia. Similarly, increasing the cycle lengthfrom 200 or 400 to 600 ms eliminated APD alternans up to 6 minof ischaemia and significantly reduced its magnitude between7 and 10 min within a few beats. We conclude that persistent APD alternans is a characteristicfinding in the rabbit heart during global ischaemia. It is asensitive parameter of the severity of ischaemia and dependson the degree and duration of ischaemia as well as on the preload.The CL appears to have an independent effect on the generationof APD alternans, which is functionally separate from the effectof CL on the ischaemic burden. An eventual impact of these observationscould be the application of APD alternans as a diagnostic toolin electrophysiological examinations of myocardial ischaemiain experimental and clinical settings.