Evidence map›Paper›PMID 39425059›Full record

ArticleBMC anesthesiology2024

Startle sign events induced by mechanical manipulation during surgery for neuroma localization: a retrospective cohort study.

Jonathan M Gorky, Sarah J Karinja, Sylvia L Ranjeva, Lingshan Liu, Matthew R Smith, Ariel L Mueller, Timothy T Houle, Kyle R Eberlin, Katarina J Ruscic

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In one paragraph

Article in BMC anesthesiology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Jonathan M GorkyDepartment of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA.
Sarah J KarinjaDivision of Plastic and Reconstructive Surgery, The Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Sylvia L RanjevaDepartment of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA.
Lingshan LiuDepartment of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA.
Matthew R SmithDepartment of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA.
Ariel L MuellerDepartment of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA.
Timothy T HouleDepartment of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA.
Kyle R EberlinDivision of Plastic and Reconstructive Surgery, The Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
Katarina J RuscicDepartment of Anesthesia, Critical Care and Pain Medicine, The Massachusetts General Hospital, 55 Fruit Street, GRB444, Boston, MA, 02114, USA. kruscic@mgh.harvard.edu.

Funding

Research Training for AnesthetistsT32GM007592 · NIGMS · MASSACHUSETTS GENERAL HOSPITAL · PI STUART A FORMAN · 1985 to 2026
$11.8M
The Impact of Anesthetics on Lymphatic Vessel Contractility and Extracellular Fluid UptakeK08GM155886 · NIGMS · MASSACHUSETTS GENERAL HOSPITAL · PI Katarina J Ruscic · 2024 to 2026
$394k
Harvard Medical School Eleanor and Miles Shore AwardInternational Anesthesia Research Society Mentored Research AwardNIGMS NIH HHS K08 GM155886NIGMS NIH HHS T32 GM007592NIGMS NIH HHS T32-GM007592
6 · The paper itself

Abstract

backgroundChronic pain from peripheral neuromas is difficult to manage and often requires surgical excision, though intraoperative identification of neuromas can be challenging due to anatomical ambiguity. Mechanical manipulation of the neuroma during surgery can elicit a characteristic "startle sign", which can help guide surgical management. However, it is unknown how anesthetic management affects detection of the startle sign.

methodsWe performed a retrospective cohort study of 73 neuroma excision surgeries performed recently at Massachusetts General Hospital. Physiological changes in the anesthetic record were analyzed to identify associations with a startle sign event. Anesthesia type and doses of pharmacological agents were analyzed between startle sign and no-startle sign groups.

resultsOf the 64 neuroma resection surgeries included, 13 had a startle sign. Combined intravenous and inhalation anesthesia (CIVIA) was more frequently used in the startle sign group vs. no-startle sign group (54% vs. 8%), while regional blockade with monitored anesthetic care was not associated with the startle sign group (12% vs. 0%), p = 0.001 for anesthesia type. Other factors, such as neuromuscular blocking agents, ketamine infusion, remifentanil infusion, and intravenous morphine equivalents showed no differences between groups.

conclusionsHere, we identified hypothesis-generating descriptive differences in anesthetic management associated with the detection of the neuroma startle sign during neuroma excision surgery, suggesting ways to deliver anesthesia facilitating detection of this phenomenon. Prospective trials are needed to further validate the hypotheses generated.

Indexed as

NeuromaAdultAgedCohort StudiesFemaleHumansMaleMiddle AgedReflex, StartleRetrospective StudiesChronic pain managementCombined intravenous and inhaled anesthesia (CIVIA)Intraoperative monitoringNeuroma identificationNeuroma startle signNeuroma surgeryPeripheral nerve blockadeStartle reactionStartle responseStartle sign

Identifiers

PMID39425059
PMCPMC11487699

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.