Avoid hypotension and hypoxia: an old anesthetic adage with renewed relevance from cerebral oximetry monitoring

Influence of variations in systemic blood flow and pressure on cerebral and systemic oxygen saturation in cardiopulmonary bypass patients

“…28 Therefore, the utility of NIRS for individualization of perioperative pressure and blood flow management awaits testing in properly designed and executed clinical trials. 29 In conclusion, in the elective cardiac surgery population used in this study, changes in flow affected cerebral and systemic oxygen balance more than changes in pressure. Moreover, arterial pressure increase with phenylephrine elicited reduced cerebral and systemic oxygen saturation.…”

Impact of Extracranial Contamination on Regional Cerebral Oxygen Saturation

“…22 There is an emerging concept of targeting mean arterial pressure specifically to a patient's CBF autoregulatory range, as opposed to a set mean arterial pressure value for all patients, which may help protect from cerebral hypoperfusion. 23 Recent studies have suggested that NIRS measurements of rSO 2 reliably represent CBF autoregulation in patients undergoing CPB. 22 If, however, rSO 2 measurements contain contamination from extracranial tissue, the specificity of these measurements to determine cerebral autoregulation becomes questionable.…”

Monitoring the brain in cardiac surgery – an evolving area for research

“…One of the potential utilities to cerebral oximetry is in individualising the care of patients [32]. An emerging field of research was highlighted recently by Joshi et al in a study that used NIRS to determine the optimal position on the autoregulatory curve for these patients [33].…”