Clinical Applications of Near-infrared Spectroscopy Monitoring in Cardiovascular Surgery

Hogue, Charles W.; Levine, Annabelle; Hudson, Alexander; Lewis, Choy

doi:10.1097/aln.0000000000003700

Cited by 25 publications

(27 citation statements)

References 49 publications

(69 reference statements)

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“…Although the exact pathophysiology of secondary TBI is unclear, decreased cerebral perfusion and oxygenation are closely related mechanisms [ 1 ]. Cerebral oxygenation is well known as a potentially modifiable risk factor for TBI, and if insufficient cerebral oxygenation can be accurately and timely detected, it can be improved through adaptation/correction of the relevant variables [ 5 , 19 , 21 ]. Therefore, NIRS can be a practical option for perioperative rSO 2 monitoring, as it provides an opportunity for the early detection of cerebral oxygen supply/demand imbalance.…”

Section: Discussionmentioning

confidence: 99%

“…We observed desaturations greater than 10% from baseline in 50% of patients, and greater than 20% from baseline in 30% of patients. In one study on cardiac surgery, corresponding decrements occurred in 60% and 40% of patients, respectively [ 21 ]. The absolute baseline, maximal, and minimal values were also 8–10% higher in patients with mild TBI than in patients undergoing cardiac surgery (online Supplementary Material Table S1 ) [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Magnesium Sulfate and Cerebral Oxygen Saturation in Mild Traumatic Brain Injury: A Randomized, Double-Blind, Controlled Trial

Sohn

Ahn

wonseok

et al. 2022

JCM

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Perioperative cerebral hypoperfusion/ischemia is considered to play a pivotal role in the development of secondary traumatic brain injury (TBI). This prospective randomized, double-blind, controlled study investigated whether magnesium sulfate (MgSO4) infusion was associated with neuroprotection in maintaining regional cerebral oxygen saturation (rSO2) values in patients with mild TBI undergoing general anesthesia. Immediately after intubation, we randomly assigned patients with TBI to receive either intravenous MgSO4 (30 mg/kg for 10 min, followed by a continuous infusion of 15 mg/kg/h) or a placebo (saline) during surgery. We also implemented an intervention protocol for a sudden desaturation exceeding 20% of the initial baseline rSO2. The intraoperative rSO2 values were similar with respect to the median (left. 67% vs. 66%, respectively; p = 0.654), lowest, and highest rSO2 in both groups. The incidence (left 31.2% vs. 24.3%; p = 0.521) and duration (left 2.6% vs. 3.5%; p = 0.638) of cerebral desaturations (the relative decline in rSO2 < 80% of the baseline value) were also similar for both groups. Although the patients suffered serious traumatic injuries, all critical desaturation events were restored (100%) following stringent adherence to the intervention protocol. Intraoperative remifentanil consumption, postoperative pain intensity, and fentanyl consumption at 6 h were lower in the MgSO4 group (p = 0.024, 0.017, and 0.041, respectively) compared to the control group, whereas the satisfaction score was higher in the MgSO4 group (p = 0.007). The rSO2 did not respond to intraoperative MgSO4 in mild TBI. Nevertheless, MgSO4 helped the postoperative pain intensity, reduce the amount of intraoperative and postoperative analgesics administered, and heighten the satisfaction score.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Magnesium Sulfate and Cerebral Oxygen Saturation in Mild Traumatic Brain Injury: A Randomized, Double-Blind, Controlled Trial

Sohn

Ahn

wonseok

et al. 2022

JCM

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“…The NIRS system is a noninvasive monitor that detects tissue oxygenation saturation. Oxyhemoglobin and deoxyhemoglobin absorb different wavelengths of near infrared light that allows for the ratio of oxygenated hemoglobin to total hemoglobin to be calculated 58. NIRS valves can be altered by several variables including temperature, sedation levels, ECMO flow rates, CO 2 , and others.…”

Section: Monitoring Patient Hemodynamicsmentioning

confidence: 99%

Mechanical circulatory support in the intensive care unit

Sommer

Nunnally

2022

International Anesthesiology Clinics

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“…The current methods to assess oxygen delivery to the brain include measuring blood pressure and arterial oxygenation via pulse oximetry or blood gas analysis which are surrogate parameters ( Pollard et al, 1996 ). Near-infrared spectroscopy (NIRS), a non-invasive cerebral oximetry monitor, has been introduced to directly measure regional cerebral oxygen saturation (rScO 2 ) ( Wahr et al, 1996 ; Owen-Reece et al, 1999 ; Vegh, 2016 ; Hogue et al, 2021 ). The light in the near-infrared spectrum can penetrate tissue containing bone and soft tissue/gray matter up to 2.5 cm in depth.…”

Section: Introductionmentioning

confidence: 99%

“…In order to perform cerebral oximetry monitoring, a pair of adhesive sensors are attached to the right and left sides of the forehead of the patient to measure the rScO 2 of the frontal cortex ( Hogue et al, 2021 ). The frontal cortex receives blood supply from two branches of the internal carotid artery: the anterior and the middle cerebral artery ( El-Baba & Schury, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Correlation and agreement of regional cerebral oxygen saturation measured from sensor sites at frontal and temporal areas in adult patients undergoing cardiovascular anesthesia

Tribuddharat¹,

Ngamsaengsirisup²,

Mahothorn³

et al. 2022

PeerJ

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Background The function and viability of the brain depend on adequate oxygen supply. A decrease in cerebral blood supply causing cerebral desaturation may lead to many neurological complications. Direct measurement of regional cerebral oxygen saturation (rScO 2 ) assists in early detection and management. Near-infrared spectroscopy (NIRS) has been introduced for measuring rScO 2 . A pair of sensors are attached to the right and left forehead. However, there are some situations where the forehead of the patient is not accessible for sensor attachment ( e.g ., neurosurgery involving the frontal area; a bispectral index (BIS) sensor already attached, or a wound to the forehead); therefore, alternate sites for sensor attachment are required. The temporal area was proposed as an alternate site. The objective of this study was to assess the correlation and agreement of rScO 2 measured at the forehead vs . the temporal area. Methods Adult patients undergoing cardiothoracic or vascular surgery were monitored for rScO 2 using two pairs of ForeSight sensors. The first pair (A1 and A2) were attached to the right and left forehead, while the second pair (B1 and B2) were attached to the right and left temporal area. The rScO 2 values measured from A1 vs . B1 and A2 vs . B2 were assessed for correlation and agreement using the Bland-Altman analysis. Results Data from 19 patients with 14,364 sets of data were analyzed. The data from A1 vs . B1 and A2 vs . B2 showed moderate positive correlation (r = 0.627; P < 0.0001 and r = 0.548; P < 0.0001). The biases of A1 vs . B1 and A2 vs . B2 were −2.3% (95% CI [−2.5 to −2.2]; P < 0.0001) and 0.7% (95% CI [0.6–0.8]; P < 0.0001). The lower and upper limits of agreement of A1 vs . B1 were −17.5% (95% CI [−17.7 to −17.3]) and 12.8% (95% CI [12.6–13.0]). The lower and upper limits of agreement of A2 vs . B2 were −14.6% (95% CI [−14.8 to −14.4]) and 16.0% (95% [CI 15.8–16.3]). Conclusions The rScO 2 values measured from sensors at the frontal and temporal areas show a moderate correlation with sufficiently good agreement. The temporal area may be an alternative to the frontal area for cerebral oximetry monitoring.

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Clinical Applications of Near-infrared Spectroscopy Monitoring in Cardiovascular Surgery

Cited by 25 publications

References 49 publications

Magnesium Sulfate and Cerebral Oxygen Saturation in Mild Traumatic Brain Injury: A Randomized, Double-Blind, Controlled Trial

Magnesium Sulfate and Cerebral Oxygen Saturation in Mild Traumatic Brain Injury: A Randomized, Double-Blind, Controlled Trial

Mechanical circulatory support in the intensive care unit

Correlation and agreement of regional cerebral oxygen saturation measured from sensor sites at frontal and temporal areas in adult patients undergoing cardiovascular anesthesia

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