Accuracy of Cerebral Monitoring in Detecting Cerebral Ischemia during Carotid Endarterectomy

Moritz, Stefan; Kasprzak, Piotr; Arlt, Matthias; Taeger, K.; Metz, Christoph

doi:10.1097/01.anes.0000281894.69422.ff

Cited by 290 publications

(76 citation statements)

References 30 publications

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“…In this study, the previously applied threshold of a 20 per cent reduction in rScO 2 from baseline had a low sensitivity (30%) but a very high specificity (98%), with positive and negative predictive values of 37 per cent and 98 per cent, respectively. Other studies have demonstrated similar accuracy and reproducibility for NIRS in the detection of cerebral ischaemia compared with other monitoring modalities [26].…”

Section: (B) Carotid Endarterectomymentioning

confidence: 77%

Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy

Smith

2011

Phil. Trans. R. Soc. A.

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Near-infrared spectroscopy (NIRS) has potential as a non-invasive brain monitor in a wide range of clinical scenarios. In the last decade, there has been a rapid expansion of clinical experience using NIRS to monitor cerebral oxygenation, particularly in cardiac surgery, where there is some evidence that NIRS-guided brain protection protocols might lead to a reduction in peri-operative neurological complications. There are no data to support the wider application of NIRS to monitor cerebral oxygenation during routine anaesthesia and surgery, and its application in brain injury, where it might be expected to have a key monitoring role, is as yet undefined. Technological developments, including the introduction of broadband and time-resolved spectrometers that are capable of reliably measuring changes in oxidized cytochrome c oxidase, offer real potential for a single NIRS-based device to provide multi-site, regional monitoring of cerebral metabolic status as well as oxygenation and haemodynamics.

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Section: (B) Carotid Endarterectomymentioning

confidence: 77%

Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy

Smith

2011

Phil. Trans. R. Soc. A.

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“…Kishi et al investigated the rSO 2 values in the brain obtained after a sensor position at different sites on the forehead and also the impact of factors such as patient characteristics and hemoglobin concentration [8]. The sensor location, age and hemoglobin all are determinants of the rSO 2 values. An inverse relationship was found between age and rSO 2 values and a direct relationship between hemoglobin and rSO 2 values [8].…”

Section: Discussionmentioning

confidence: 99%

“…The method has been validated and used extensively during carotid endarterectomy to monitor the rSO 2 values during carotid clamping [2,3]. It has also been used in stroke and cardiac arrest patients to detect desaturation of the metabolically active brain but may exhibit normal values in the absence of cerebral perfusion [4].…”

Section: Introductionmentioning

confidence: 99%

Measurements of oxygen saturation of brain, liver and heart areas in the supine and sitting position using near infrared spectrophotometry

Τsaroucha

Paraskeva

Fassoulaki

2017

Rom J Anaesth Intensive Care

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Background and aims: Regional oxygen saturation (rSO 2 ) monitoring of the brain by near-infrared spectroscopy (NIRS) has been mainly used during carotid endarterectomy. The present study was conducted in volunteers and investigates the rSO 2 values of the brain, heart and liver tissue as assessed by NIRS in the supine and the sitting position.Methods: After obtaining written informed consent from forty-nine healthy volunteers, rSO 2 values were recorded in the heart and liver areas in the supine and the sitting position, while simultaneously the rSO 2 values of the brain.Results: The rSO 2 brain values in the supine and the sitting position were 69 ± 6.0 and 66 ± 6.1 respectively (p = 0.0001). The rSO 2 values in the supine and the sitting position were 76 ± 10.5 and 79 ± 6.7 for the heart (p > 0.05) and 85 ± 6.8 and 82 ± 7.2 for the liver, (p = 0.007). Heart rSO 2 values were higher than the brain rSO 2 values in both the supine (76 ± 10.4 versus 69 ± 6.6; p = 0.0001) and the sitting position (79 ± 6.7 versus 66 ± 6.1; p = 0.0001). The liver rSO 2 values were also higher than the brain rSO 2 values in the supine (85 ± 6.8 versus 69 ± 6.0; p = 0.0001) and in the sitting position (82 ± 7.2 versus 66 ± 5.7; p = 0.0001). Arterial blood pressure and arterial oxygen saturation (SpO 2 ) did not differ between the two positions but the heart rate was higher in the sitting position (p = 0.030).Conclusions: We conclude that brain and liver (but not heart) rSO 2 values are higher in the supine than sitting position. Additionally, NIRS may be used to assess oxygenation of the heart and liver.

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“…6 (3) The selective shunter: this group only shunts patients at risk of cerebral hypoperfusion during cross-clamp based on either preoperative considerations or intraoperative monitoring. 6,7 Although some patients have identifiable preoperative risk factors (e.g., contralateral occlusion or recent stroke), the majority of patients do not. Thus, it is important to have a real-time intraoperative monitor that can reliably provide information about the adequacy of the cerebral circulation during interruption of the ipsilateral circulation to guide surgical or anesthetic management (i.e., a shunt or arterial blood pressure management indicator).…”

Section: Surgical Approachesmentioning

confidence: 99%

Monitoring for Carotid Endarterectomy

Lam¹,

Kianpour

2015

Anesthesia &Amp; Analgesia

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Accuracy of Cerebral Monitoring in Detecting Cerebral Ischemia during Carotid Endarterectomy

Cited by 290 publications

References 30 publications

Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy

Shedding light on the adult brain: a review of the clinical applications of near-infrared spectroscopy

Measurements of oxygen saturation of brain, liver and heart areas in the supine and sitting position using near infrared spectrophotometry

Monitoring for Carotid Endarterectomy

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