Bilaterales Monitoring der zerebralen Sauerstoffsättigung in der Aortenbogen-Chirurgie

Abstract

Cerebral ischemia with consecutive neurological damage is a typical complication in aortic arch surgery. Therefore, intraoperative neuromonitoring is of increasing interest. This paper describes the role of bilateral near-infrared-spectroscopy (NIRS) in detecting cerebral ischemia. In the case of a patient with acute aortic dissection (Daily, type A), an unexpected sudden reduction of perfusion of the right carotid artery could easily be detected with the help of two instruments INVOS 3100A. The decrease in the saturation values from 74% to 54% correlated well with the drop of blood pressure in the right radial artery. Clamping of the aorta with interruption of the blood flow into the innominate artery through the false lumen was the reason for the low cerebral perfusion. After repositioning the aortic clamp NIRS in combination with invasive blood pressure monitoring sufficiently allowed to control the further course of cerebral perfusion. The NIRS is a non-invasive, easy to handle, and easy to interpret method for intraoperative monitoring of the neurological status. Therefore in our opinion it has got some relevant advantages in contrast to other neuromonitoring methods in aortic arch surgery.

Use of cerebral oximetry to detect and manage cerebral desaturation with a rapidly expanding neck hematoma

“…Infrared spectroscopy is used to monitor brain perfusion during carotid endarterectomy and other situations in which brain ischemia is likely (4–6). It has also been used to detect reduced oxygen saturation when there is a carotid obstruction because of head rotation (7) or a malpositioned aortic clamp (8). In this report, we present a case in which cerebral oximetry detected potentially catastrophic cerebral desaturation because of compression of the carotid arteries and decreased venous return.…”