Continuous jugular bulb venous oxygen saturation validation and variations during intracranial aneurysm surgery

Clavier, N.; Schurando, Patrick; Raggueneau, J L; Payen, Didier

doi:10.1016/s0883-9441(97)90040-x

Cited by 12 publications

(4 citation statements)

References 32 publications

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“…Severe cerebral hyperperfusion, called cerebral hyperperfusion syndrome, can cause unilateral headaches, face and eye pain, seizures, deterioration of consciousness levels, and focal neurological deficits . A number of authors have described less severe cerebral hyperaemia after various brain surgeries . Low level of arteriovenous oxygen content difference (AVDO 2 ) in the immediate post‐operative period was shown in Asmussen J et al.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral hyperaemia after isoflurane anaesthesia for craniotomy of patients with supratentorial brain tumour

et al. 2013

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 99%

“…Several studies have described the occurrence of cerebral hyperaemia after craniotomy . Post‐operative cerebral hyperperfusion increases the risk of disastrous complications, such as intracranial hypertension, cerebral oedema, and intracerebral haemorrhage .…”

mentioning

confidence: 99%

Cerebral hyperaemia after isoflurane anaesthesia for craniotomy of patients with supratentorial brain tumour

et al. 2013

Acta Anaesthesiol Scand

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“…38,40 Therefore, the cerebral hemodynamic and metabolic balance may be altered during aneurysm surgery. 41 Jugular bulb venous oximetry allows continuous or intermittant estimation of the global balance between cerebral oxygen demand and supply. A SjVO 2 greater than 90% is indicative of absolute relative hyperemia.…”

Section: Discussionmentioning

confidence: 99%

Effects of use of Thiopental + Mannitol or Etomidate + Mannitol on Cerebral Ischemia During Temporary Occlusion of Middle Cerebral Artery in Intracranial Aneurysm Surgery

Boztuğ¹,

Bıgat²,

z³

et al. 2005

Neurosurgery Quarterly

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Temporary vessel occlusion is an effective technique used by microvascular surgeons to facilitate dissection and permanent clipping of cerebral aneurysms. Prolonged temporary occlusion carries the risk of infarction in the territory distal to the point of occlusion. The risk of infarction can be reduced by reducing the oxygen requirements of the brain and by maintaining collateral circulation by means of blood pressure control. We studied the effects in 90 patients of etomidate + mannitol or thiopental + mannitol usage during temporary clipping in aneurysm surgery on SjVO 2 . group 1 received thiopental + mannitol and group 2 received etomidate + mannitol for protection before temporary clipping. After normalization of blood pressure (mild hypertension, mean arterial pressure 90-110 mm Hg) a temporary clip was used. Blood samples were taken from the jugular venous bulb catheter to assess SjVO 2 at intervals during the procedure. Postoperative radiologic and clinical ischemia were evaluated with a CT scan and neurologic examination. In group 1, 6 patients were given inotropic agent infusion to maintain mean arterial pressure. However, in group 2, the inotropic agent was not required. SjVO 2 values increased more than 80% in 1 patient in group 1 and in 2 patients in group 2. A new radiographic stroke was observed in 2 patients in group 2. When etomidate + mannitol was used for protection before temporary clipping, cerebral infaction appeared to be permanent as a result of the prolonged occlusion time. The results of this clinical study need further investigation.

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“…It may help, in the early recognition of the potential for cerebral ischaemia associated with hyperventilation, 61 in the intraoperative blood pressure management 69 and in the detection of hyperaemia and luxury perfusion. 13 As with neurophysiological monitoring, it may be of value during temporary occlusion of the artery feeding the aneurysm as a means of judging the adequacy of collateral perfusion. The potential but unproven benefits of such intraoperative monitoring on outcome must be carefully balanced against the risk of impaired cerebral venous drainage (associated with head-down and head-turning position during placement and with location of the catheter tip in the jugular bulb).…”

Section: Neurophysiological Monitoringmentioning

confidence: 99%

Aneurysmal subarachnoid haemorrhage and the anaesthetist

Priebe

2007

British Journal of Anaesthesia

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The anaesthetist may be involved at various stages in the management of subarachnoid haemorrhage (SAH). Thus, familiarity with epidemiological, pathophysiological, diagnostic, and therapeutic issues is as important as detailed knowledge of the optimal intraoperative anaesthetic management. As the prognosis of SAH remains poor, prompt diagnosis and appropriate treatment are essential, because early treatment may improve outcome. It is, therefore, important to rule out SAH as soon as possible in all patients complaining of sudden onset of severe headache lasting for longer than an hour with no alternative explanation. The three main predictors of mortality and dependence are impaired level of consciousness on admission, advanced age, and a large volume of blood on initial cranial computed tomography. The major complications of SAH include re-bleeding, cerebral vasospasm leading to immediate and delayed cerebral ischaemia, hydrocephalus, cardiopulmonary dysfunction, and electrolyte disturbances. Prophylaxis and therapy of cerebral vasospasm include maintenance of cerebral perfusion pressure (CPP) and normovolaemia, administration of nimodipine, triple-H therapy, balloon angioplasty, and intra-arterial papaverine. Occlusion of the aneurysm after SAH is usually attempted surgically ('clipping') or endovascularly by detachable coils ('coiling'). The need for an adequate CPP (for the prevention of cerebral ischaemia and cerebral vasospasm) must be balanced against the need for a low transmural pressure gradient of the aneurysm (for the prevention of rupture of the aneurysm). Effective measures to prevent or attenuate increases in intracranial pressure, brain swelling, and cerebral vasospasm throughout all phases of anaesthesia are prerequisite for optimal outcome.

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Continuous jugular bulb venous oxygen saturation validation and variations during intracranial aneurysm surgery

Cited by 12 publications

References 32 publications

Cerebral hyperaemia after isoflurane anaesthesia for craniotomy of patients with supratentorial brain tumour

Cerebral hyperaemia after isoflurane anaesthesia for craniotomy of patients with supratentorial brain tumour

Effects of use of Thiopental + Mannitol or Etomidate + Mannitol on Cerebral Ischemia During Temporary Occlusion of Middle Cerebral Artery in Intracranial Aneurysm Surgery

Aneurysmal subarachnoid haemorrhage and the anaesthetist

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