Procedures In Adult Patients Research Articles

Pain Score within Twenty-Four Hours Post-Endoscopic Ultrasonography: A Comparison Between with or without Fine Needle Aspiration Procedure

AIMS: To compare the pain score within twenty-four hours post-endoscopic ultrasonography (EUS) with or without fine needle aspiration (FNA) procedure in adult patients. METHODS: We prospectively analyzed the patients who underwent EUS procedures from January, 2009 to December, 2009. Pain score was compared by using verbal rating scale (VRS, 0-100) and pain rescued medications at 2, 6, 12, 18, 24 hours post-procedure. RESULTS: One hundred and twenty-four patients, 84 patients only with EUS procedure (group D) and 40 patients with EUS and FNA procedures (group F), were enrolled. All procedures were completed successfully. Sedative and analgesic agents in both groups were propofol, midazolam and fentanyl and were comparable the dose among the two groups. The mean procedural time in D and F was 39.8±19.1 and 60.6±26.0 minutes, respectively. Mean pain score at baseline and at 2, 6, 12, 18 and 24 hours post-EUS was not significantly different between the two groups. Additionally, total dose of pethidine used for pain control after EUS procedure in both groups was not significantly different. CONCLUSION: EUS-induced abdominal pain is mild and mainly occurs within six hours after the procedure. Pain score within twenty-four hours after EUS with or without fine needle aspiration procedure is comparable.

Evaluation of complication rates of pediatric cranial procedures in which a polyethylene glycol sealant was used.

Polyethylene glycol (PEG) sealant in conjunction with standard closure techniques is effective in preventing CSF leaks after cranial procedures in adult patients, but the safety of PEG sealant in the pediatric population has not been shown. The authors performed a retrospective analysis of pediatric neurosurgery patients (0-18 years of age) treated from 2005 to 2010 at The Johns Hopkins Hospital. There were 163 patients who underwent cranial surgery with the use of PEG sealant as an adjunct to standard closure techniques. There were 92 males and 71 females with an average age of 10.2 years. The incidences of revision surgery, CSF leak, meningitis, and neurological deficit were recorded. In the cohort's 90-day postoperative clinical course, the authors found that 4 patients (2.5%) required revision surgery, 2 patients (1.2%) developed a CSF leak, 4 patients (2.5%) developed a superficial skin infection, and 1 patient developed meningitis (0.6%) with no deaths or neurological deficits observed. PEG sealant appears to be a safe adjunct to standard dural closure in pediatric cranial surgery patients to augment dural closure.

Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients.

Introduction:Intraoral local anesthesia is essential for delivering dental care. Needless devices have been developed to provide anesthesia without injections. Little controlled research is available on its use in dental restorative procedures in adult patients. The aims of this study were to compare adult patients acceptability and preference for needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia.Materials and Methods:Twenty non fearful adults with no previous experience of dental anesthesia were studied using split-mouth design. The first procedure was performed with classical needle infiltration anesthesia. The same amount of anesthetic solution was administered using MADA jet needleless device in a second session one week later, during which a second dental restorative procedure was performed. Patients acceptance was assessed using Universal pain assessment tool while effectiveness was recorded using soft tissue anesthesia and pulpal anesthesia. Patients reported their preference for the anesthetic method at the third visit. The data was evaluated using chi square test and student's t-test.Results:Pressure anesthesia was more accepted and preferred by 70% of the patients than traditional needle anesthesia (20%). Both needle and pressure anesthesia was equally effective for carrying out the dental procedures.Conclusion:Patients experienced significantly less pain and fear (p<0.01) during anesthetic procedure with pressure anesthesia. However, for more invasive procedures needle anesthesia will be more effective.

Risks of complications by attending physicians after performing nighttime procedures

Objective: To determine whether sleep opportunities for attending surgeons and obstetricians/gynecologists are associated with the risk of complications. Design: Matched retrospective cohort study of procedures performed from 1999 to 2008 by attending physicians (86 surgeons, 134 obstetricians/gynecologists) who had been in hospital performing another procedure in adult patients for at least part of the preceding night (12:00–6:00 am postnighttime procedures). Results: A total of 9191 surgical and 957 obstetrical postnighttime procedures were matched with 3552 and 3945 control procedures, respectively. Complications occurred in 101 postnighttime procedures (5.4%) and 365 control procedures (4.9%; odds ratio [OR] 1.09, 95% confidence interval [CI] 0.84–1.41). Complications occurred in 82 of 1317 (6.2%) postnighttime procedures performed by surgeons who had 6 hours of sleep or fewer versus 19 of 559 (3.4%) postnighttime procedures performed by surgeons who had more than 6 hours of sleep (OR 1.72, 95% CI 1.02–2.89). Postnighttime procedures completed after working more than 12 hours (n = 958) compared with 12 hours or fewer (n = 918) had nonsignificantly higher complication rates (6.5% v. 4.3%; OR 1.47, 95% CI 0.96–2.27). Conclusion: Overall, procedures performed the day after attending physicians worked overnight were not associated with significantly increased complication rates, although there was an increased rate of complications for postnighttime procedures performed by physicians who had fewer than 6 hours of sleep.

Age-dependent safety analysis of propofol-based deep sedation for ERCP and EUS procedures at an endoscopy training center in a developing country

IntroductionEndoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) procedures in elderly patients are on the rise, and they play an important role in the diagnosis and management of various gastrointestinal diseases. The use of deep sedation in these patients has been established as a safe and effective technique in Western countries; however, it is uncertain if the situation holds true among Asians. The present study aimed to evaluate the age-dependent safety analysis and clinical efficacy of propofol-based deep sedation (PBDS) for ERCP and EUS procedures in adult patients at a World Gastroenterology Organization (WGO) Endoscopy Training Center in Thailand.MethodsWe undertook a retrospective review of anesthesia or sedation service records of patients who underwent ERCP and EUS procedures. All procedures were performed by staff endoscopists, and all sedations were administered by anesthesia personnel in the endoscopy room.ResultsPBDS was provided for 491 ERCP and EUS procedures. Of these, 252 patients (mean age, 45.1 + 11.1 years, range 17–65 years) were in the <65 age group, 209 patients (mean age, 71.7 + 4.3 years, range 65–80 years) were in the 65–80 year-old group, and 30 patients (mean age, 84.6 + 4.2 years, range 81–97 years) were in the >80 age group. Common indications for the procedures were pancreatic tumor, cholelithiasis, and gastric tumor. Fentanyl, propofol, and midazolam were the most common sedative drugs used in all three groups. The mean doses of propofol and midazolam in the very old patients were relatively lower than in the other groups. The combination of propofol, midazolam, and fentanyl, as well as propofol and fentanyl, were frequently used in all patients. Sedation-related adverse events and procedure-related complications were not statistically significantly different among the three groups. Hypotension was the most common complication.ConclusionIn the setting of the WGO Endoscopy Training Center in a developing country, PBDS for ERCP and EUS procedures in elderly patients by trained anesthesia personnel with appropriate monitoring is relatively safe and effective. Although adverse cardiovascular events, including hypotension, in this aged group is common, all adverse events were usually transient, mild, and easily treated, with no sequelae.

PWE-205 Propofol-balanced anaesthesia for single balloon enteroscopy: a comparison between antegrade and retrograde intubation

IntroductionSingle balloon enteroscopy (SBE) procedure is a procedure for diagnosis and treatment in patients with abnormality of gastrointestinal tract especially for small bowel. It commonly performed either anterograde or retrograde...

The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk

In western countries, the process of "ageing of the population" is increasingly forcing clinical medicine to find answers for pathologies affecting the elder segments of our community. In this respect, pituitary adenomas often raise difficult questions on surgical indications, since little is known about postoperative morbidity and mortality in elderly patients. The transsphenoidal endonasal approach (TNS), which is considered the gold standard for surgical resection of the majority of functioning and non-functioning pituitary adenomas, is supposed to be a low morbidity and mortality procedure in adult patients. However, only a few contradicting data are available in the literature about elderly patients. In this paper we retrospectively analyze a cohort of 43 consecutive patients aged more than 65years, operated on for pituitary adenomas at our Institution in the years 1998-2007. These patients were treated by transsphenoidal endonasal approach (TNS) for resection of non-functioning pituitary adenomas (n=31), GH-secreting adenomas (n=4) and ACTH-secreting adenomas (n=8). Clinical records reported a macroadenoma with tumour-related mass symptoms in about 80% of patients; single or multiple pituitary deficits were present in 44% of patients. Regarding comorbidities, cardiac disease was the most frequently observed (86%); assessment of anaesthesiological risk indicated a moderate to severe ASA score in most patients, 11% showing a 4-5 score. On the basis of current criteria, our retrospective analysis revealed that cure was achieved in 54% of patients. The outcome was similar to that observed in the general population of patients undergoing transphenoidal surgery in our centre, without differences in the rate of surgical and endocrinological cure, minor and major surgical complications and hospitalization duration. In particular, no significant anaesthesiological complications were observed and no patient developed either permanent diabetes insipidus or cerebrospinal fluid rhinorrhea. In conclusion, in specialized centres the surgical treatment of pituitary adenomas via the transsphenoidal route can be a safe and effective procedure even in elderly patients.

Transcatheter Closure of a Large Atrial Septal Defect under Microprobe Transesophageal Echocardiographic Guidance

We present a case of an atrial septal defect (ASD) in a 59-year-old man with an indication for ASD closure who also had a history of chronic obstructive pulmonary disease. Because of his decreased respiratory function with multiple bullae in his lungs, the procedure was performed without general anesthesia under the guidance of fluoroscopy and two-dimensional (2D) transesophageal echocardiography (TEE) using a transesophageal echocardiographic microprobe (micro-TEE) (S8-3t; Philips Medical Systems, Andover, MA, USA). The micro-TEE probe was inserted into the esophagus smoothly and easily in the supine position without sedation. It revealed a deficient superior-anterior rim and adequate rims elsewhere, and the maximal diameter of ASD was measured to be 25 mm. Balloon sizing resulted in a stretched defect diameter of 29 mm using the stop-flow technique. A 30-mm AMPLATZER Septal Occluder (AGA Medical, Plymouth, MN, USA) was deployed. The micro-TEE demonstrated that both disks were on the appropriate sides of the interatrial septum and the device was not interfering with surround cardiac structures. Residual shunt flow was not detected with color Doppler. The device was released successfully without any complications. Recently introduced multiplane micro-TEE can provide adequate information about a large ASD with a less invasive procedure in adult patients. Micro-TEE has a potential to become a novel imaging option for interventions of the interatrial septum.

Pain score within twenty-four hours post-endoscopic ultrasonography: a comparison of diagnostic with or without fine needle aspiration procedure

Aim: To compare the pain score within twenty-four hours post-endoscopic ultrasonography (EUS) between the diagnostic with or without fine needle aspiration (FNA) procedure in adult patients.

Oral ketamine for wound care procedures in adult patients with burns

Background: This prospective study was carried out to evaluate the usefulness of oral ketamine for burn wound dressing in adult patients. The aim was to achieve a state-of-conscious sedation in which the patient would be communicative and cooperative, with minimal, or no pain during burn wound care procedures. Method: Two hundred and forty wound care procedures were randomly assigned to six treatment groups of patients (groups A-F). The quantities of oral ketamine that they received were as follows: Group A, 0.5 mg/kg; B, 2 mg/kg; C, 4 mg/kg; D, 6 mg/kg; E, 8 mg/kg and F, 10 mg/kg. A five-point verbal rating scale was used to assess pain intensity: the AVPU ( alert, voice, pain, unresponsive) scale for level of consciousness. The Likert scale was used for patient satisfaction. Blood pressure, pulse rate and oxygen saturation were monitored. Adverse effects were noted. Comparisons of the efficacy and safety of the different dosages of oral ketamine were made using the SPSS package. The efficacy criterion was verbal rating scale (VRS) ≤ 2, i.e no pain, mild pain or discomfort. Results: Patients in groups A and B reported higher levels of pain, and in groups C, D, E and F, there were varying degrees of efficacy. Groups E and F had the best analgesic profiles, but at the higher doses, some patients became anaesthetised. The most common adverse effects reported were hallucination (37%) and hypersalivation (29.9%), which occurred more frequently in groups E and F. The patients’ assessments of pain were best in Group D, and worst in Group A. Conclusion: The minimum effective subanaesthetic dose of oral ketamine for analgesia during wound care procedures in adult patients with burns was 6 mg/kg.

The diagnostic value and safety of transbronchial needle aspiration biopsy in children with mediastinal lymphadenopathy

Anterior mediastinal masses in children can have different causes which includes, Mycobacterium tuberculosis (MTB) or malignant lymphadenopathy. Transbronchial needle aspiration (TBNA) has been described as a safe and effective diagnostic procedure in adult patients with lung cancer. To describe the use of TBNA as a diagnostic test in children with large subcarinal lymphadenopathy and to determine the safety of the procedure in children. Prospective descriptive study of children with subcarinal mediastinal lymph nodes who underwent TBNA. The majority of the children were referred due to treatment failure. Children were enrolled if the diagnosis remained unclear after computer tomography of the chest. Thirty patients were enrolled in this study; TBNA was done in 28 patients. A definitive diagnosis was made by TBNA in 54% (n = 15) of patients; MTB lymphadenopathy (n = 13), metastatic nephroblastoma (n = 1), and fibrosing mediastinitis (n = 1). In seven (25%) cases the TBNA was the sole source of the specimens from which the definitive diagnosis was made. No serious complications were encountered during or after the procedure. TBNA is a safe procedure in children with mediastinal lymphadenopathy of unknown cause resulting in a definitive diagnosis in 57% of cases. TBNA adds additional value to flexible bronchoscopy in the diagnosis of mediastinal lymphadenopathy in children.

Elevated Serum Ferritin Predicts the Delay of Engraftment and High Incidence of Blood Stream Infection within 100 Days After Allogeneic Hematopoietic Stem Cell Transplantation.

Abstract 1135Poster Board I-157 BackgroundIron overload is thought to be a risk factor for morbidity and mortality in allogeneic hematopoietic stem cell transplantation (HSCT). This study particularly evaluated the impact of pre-transplant iron overload on blood stream infection (BSI) which is one of transplant related mortality (TRM) after allogeneic HSCT for hematologic malignancies. Patients and methodsThe level of serum ferritin, a surrogate marker of iron overload, was measured before the beginning of the conditioning procedure in adult patients who underwent allogeneic HSCT between January 2000 and December 2008. A total of 154 patients (pts) included 93 pts with acute myeloid leukemia (AML), 40 pts with acute lymphoid leukemia (ALL), and 21 pts with myelodysplastic syndrome (MDS). The median age was 43 years (range, 17-63 years). There were 80 males and 74 females. A disease risk at the time of transplant indicated a standard risk in 97 pts and a high risk in 57 pts. Myeloablative conditioning (MAC) was employed for 123 pts and reduced intensity conditioning (RIC) was for 31 pts. Bone marrow transplantation (BMT), peripheral blood stem cell transplantation (PBSCT), and cord blood transplantation (CBT) were done for 98, 28, and 28 pts, respectively. Logistic regression model was used for statistical analysis. ResultsThe median level of serum ferritin at pre-transplant was 1031 ng/ml (range: 31-11,500). The patients were divided into 2 groups (low ferritin group and high ferritin group) according to the median level of pre-transplant ferritin. There was no significant difference between the low and high ferritin groups for pre-transplant factors such as age, diagnosis and disease risk. Forty-three patients (28%) experienced BSI within 100 days after HSCT. In univariate analysis, the incidence of BSI was significantly low in the low ferritin group (P=0.040) and PBSCT (P=0.010). However, the incidence of BSI was not associated with age (under 50 yrs vs. more than 50 yrs), conditioning regimen (MAC vs. RIC), and disease risk (standard vs. high). Patients receiving PBSCT had significantly lower incidence of BSI by multivariate analysis (hazard ratio (HR) =0.141, 95%CI: 0.028-0.706, P=0.017). In subgroup analysis of 114 patients with AML/MDS, the low incidence of BSI was associated with PBSCT (HR=0.135, 95%CI: 0.025-0.717, P=0.019) and the low ferritin group (HR=0.352, 95%CI: 0.146-0.848, P=0.020) by multivariate analysis. The time to engraftment was shorter in the low ferritin group (median: 14 days, range: 4-41 days) compared with the high ferritin group (15 days, 0-51 days) with statistical significance (P=0.0293). Conclusions/MethodsPre-transplant serum ferritin was a predictor for TRM, especially BSI within 100 days following allogeneic HSCT. Furthermore, iron overload before transplant adversely affects the time to engraftment in myeloid malignancies, and this relationship may somewhat influence on the onset of BSI. DisclosuresNo relevant conflicts of interest to declare.

Double-blind, placebo-controlled food challenge in adults in everyday clinical practice: a reappraisal of their limitations and real indications

The double-blind, placebo-controlled food challenge (DBPCFC) is widely considered as the 'gold standard' for the diagnosis of food allergy. However, in adult patients, this procedure is rather rarely performed outside the academic context. This review article aims to reappraise the pros and cons of DBPCFC and to elicit some critical thoughts and discussions about the real indications of this diagnostic procedure in adult patients in everyday practice. There are many data showing that the DBPCFC poses a number of critical problems that are difficult to overcome in normal outpatient clinics and hospitals, and that are generally not addressed in most articles dealing with this issue. Performing DBPCFC poses a number of practical problems and has several pitfalls, which make its routine use in normal clinical settings generally impossible. This review article shows that the need for this procedure in adult patients seems in effect very little and specifies new, more limited indications to its use in everyday practice. Further, it suggests a role for the open challenge, which lacks several of the disadvantages of DBPCFC.

Interventional radiology procedures in adult patients who underwent liver transplantation

Interventional radiology has acquired a key role in every liver transplantation (LT) program by treating the majority of vascular and non-vascular post-transplant complications, improving graft and patient survival and avoiding, in the majority of cases, surgical revision and/or re-transplantation. The aim of this paper is to review indications, technical consideration, results achievable and potential complications of interventional radiology procedures after deceased donor LT and living related adult LT.

Preliminary Experience With Dexmedetomidine for Monitored Anesthesia Care During ENT Surgical Procedures

Dexmedetomidine is an alpha2-adrenergic agonist that produces anxiolysis, amnesia, sedation, potentiation of opioid analgesia, and sympatholysis. It is currently approved by the U.S. Food & Drug Administration for the sedation of adults in the intensive care setting for up to 24 hours during mechanical ventilation. Given its beneficial sedative and anxiolytic properties and limited adverse effect profile, it has been used in several other clinical scenarios. The authors present their experience using dexmedetomidine for monitored anesthesia care (MAC) during "awake" ENT procedures such as thyroplasty, a procedure requiring a patient to verbalize when requested but to otherwise remain immobile to allow for completion of the procedure, and in a patient with post-polio syndrome with poor pulmonary reserve requiring esophagoscopy with dilation and botulinum toxin injection for cricopharyngeal dysfunction. Our preliminary experience suggests that dexmedetomidine provides effective sedation as the primary agent for MAC during such procedures in adult patients. The end-organ effects of dexmedetomidine and previous reports of its use during MAC are reviewed.

Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum

Several modifications for increasing the efficacy and safety of the minimally invasive surgery (Nuss procedure) for repair of pectus excavatum in pediatric patients were presented. In this study, we apply a modified bilateral thoracoscopic approach to adapt the Nuss procedure to adult patients. We prospectively included all adult patients with pectus excavatum corrected by modified bilateral thoracoscopy-assisted Nuss repair from July 2005 to December 2007. Technical modifications included patient positioning, surgical wounds designing, and routine use of the bilateral thoracoscopy viewing before and during mediastinal dissection. The endoscopic appearances and early complications were recorded. Ninety-six adult patients (80 men, 16 women) with a mean age of 24.5 years (18-42 years) were included. Six patients were repaired due to previous failed Ravitch procedure. Pleural, mediastinal adhesions or small aberrant vessels in the mediastinal pleura were found in 19 patients. Two pectus bars were inserted in 22 patients (22.9%). The median operative time is 80 min (range from 50 to 185 min). The blood loss was mostly less than 10 cc (83 in 96 patients). In early complications, pneumothorax occurred in one (1%) patient. There was no mediastinal injury, bleeding complications, or requirement of chest tube insertion postoperatively. The mean length of hospital stay was 7.2 days (range 5-13 days). The modified bilateral thoracoscopy-assisted Nuss repair for adult patients could eliminate the risk of cardiopulmonary injuries. It could allow direct inspections in mediastinum and facilitate mediastinal dissection, especially in patients with recurrence, history of previous thoracic procedure or double-bar insertion. Other methods for ensuring safety such as substernal dissection or elevation may be unnecessary.

The Ross Procedure in Adults: Long-Term Follow-Up and Echocardiographic Changes Leading to Pulmonary Autograft Reoperation

This is a clinical investigation of the mid- to long-term follow-up of the Ross procedure in adult patients. The primary end point is to explore the incidence and risk factors for a reoperation on the pulmonary autograft. The secondary end points are to explore the incidence of neoaortic root dilation and valve regurgitation, and the echocardiographic profile leading to a reoperation. Ross operations were done in 110 adults who received at least two echocardiographic examinations for a mean follow-up time of 82 months (range, 5 to 155 months). Kaplan-Meier and Cox regression analyses were applied to assess freedom from events and risk factors for events. Freedom from reoperation on the pulmonary autograft, neoaortic root dilation, and moderate-severe neoaortic valve regurgitation were, respectively, 91.4%, 50%, and 70% at 12 years. The main risk factor for a reoperation was the degree of neoaortic valve regurgitation within the first 2 years of follow-up. Patients requiring an early (<or=4 years) reoperation had early and severe pulmonary autograft valve regurgitation, and no neoaortic root dilation. Patients needing a late (>4 years) reoperation had severe neoaortic root dilation and severe neoaortic valve regurgitation. The left ventricular end-diastolic diameter at the third year of follow-up was a risk factor for late reoperation. The Ross operation in adults is a safe procedure with good clinical results in mid- to long-term follow-up. Early reoperations are due to early neoaortic valve regurgitation, wheras late reoperations are due to progressive neoaortic root dilation.

The Lidocaine/Tetracaine Peel: A Novel Topical Anesthetic for Dermatologic Procedures in Adult Patients

The 7% lidocaine and 7% tetracaine (LT) peel is a self-occlusive, topical local anesthetic that has been proven safe and effective for use in conjunction with many dermatologic procedures, including cryotherapy, collagen injections, and various laser treatments. The product is applied directly to the skin as a cream that dries within 20 to 30 minutes of air exposure to form a flexible film membrane that is easily peeled off before surgery. The objective was to review the safety and efficacy of the LT peel in controlled, randomized trials involving adults undergoing both minor and major dermatologic procedures. All published studies involving the LT peel were reviewed, and the results of each were analyzed and collated to provide practical guidelines for clinical use. Studies comparing the LT peel with placebo or a 1:1 eutectic mixture of local anesthetics (EMLA) cream have shown the LT peel to have superior anesthetic efficacy in adult patients undergoing a variety of cutaneous procedures. The LT peel is safe and well tolerated, with side effects limited to localized, transient skin reactions that do not appear to interfere with clinical outcome. It is an effective topical anesthetic for dermatologic procedures that is convenient to use and promotes a positive patient experience.

Evaluation of surgically assisted maxillary expansion using acoustic rhinometry and postero-anterior cephalometry

Correction of maxillary transverse deficiencies is a common procedure in adult patients presenting dentofacial anomalies. Nasal characteristics of these patients, as well as the effects of these procedures upon nasal patency, have not been well described yet. In the present study, measurements performed by acoustic rhinometry and frontal cephalometry in 13 patients presenting maxillary deficiencies, before and after surgically assisted maxillary expansion (SARME), were compared with those of 10 individuals with normal dentofacial characteristics and without nasal symptoms. The variables analysed were minor cross-sectional area (MCA) and nasal volume, maxillomandibular transverse index and nasal and maxillary width. The results showed a smaller transverse width and MCA in the patients as compared with normal controls. All measurements showed a tendency to increase after SARME. The nasal volumes did not differ. The nasal width showed wide variation. There was no correlation among the variables. Patients presenting maxillary transverse deficiency seem to have lower values for nasal MCA, with a tendency to increase after SARME.

Nitric oxide test during cardiac catheterization decreases the serum concentrations of S100B protein in adult patients with idiopathic pulmonary hypertension

Objective. Cardiac catheterization (CC) is a life‐threatening procedure in adult patients. Complicated by idiopathic arterial pulmonary hypertension (IPAH), there is a potential risk of central nervous system (CNS) damage. We measured serum levels of a well‐established brain damage marker, namely S100B, collected before, during and after CC in adult patients in whom the nitric oxide (NO) test had been performed. Material and methods. In 12 adult patients who had undergone CC for IPAH diagnosis, we recorded clinical and standard monitoring procedures (laboratory variables and echocardiographic patterns) and serum concentrations of S100B before (time 0), during (time 1) and after the NO test (time 2) and at 24 h after (time 3) the procedure in samples obtained from the systemic and pulmonary circulation. Patients were subdivided into NO test responders (n = 6) and non‐responders (n = 6). Neurological evaluation was performed at admission and at discharge from hospital. Results. Adult patients subjected to CC showed no overt neurological injury at discharge from hospital. No significant differences (p>0.05 for all) in S100B serum levels between groups at times 0, 1 and 3 have been shown independently from the sampling site. It was noteworthy that the concentration of protein in the responders group at time 2 was significantly decreased (p<0.05, for all) compared to the responder group and to baseline values. A significant correlation was found between arterial oxygen partial pressure and individual S100B concentration in the pulmonary and systemic bloodstream in the entire study group (R = −0.66 and R = −0.71, respectively; p<0.05, for both). Conclusions. The data suggest that S100B protein assessment, as well as the NO test, may be useful when monitoring possible CNS damage during CC in patients with IPAH, and may also be valuable in relation to brain functions, especially when performed as an emergency procedure in severely hypoxic patients.