Near-infrared spectroscopy as an index of brain and tissue oxygenation

Murkin, John M.; Arango, Miguel

doi:10.1093/bja/aep299

Cited by 738 publications

(590 citation statements)

References 86 publications

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“…In addition, prior work has indicated that meaningful alterations in cerebral saturation can be determined in this manner, for example, pre-and post-carotid cross-clamping with carotid endarterectomy. 10,11 Lastly, establishing an a priori agreed upon baseline permits true comparisons across the maximal number of studies. 7 In these experiments, we show desaturations using the same type of cerebral oximeter (i.e., CasMed FORE-SIGHT) used by Hemmerling et al 7 This oximeter claims absolute cerebral oximetry, not just documentation of trends.…”

Section: Discussionmentioning

confidence: 99%

“…The magnitude of the mean decrease in cerebral saturation from baseline in this study is similar to that which correlated to the increased morbidity seen with carotid cross-clamping. 10 While not equivalent to an ipsilateral occlusion of blood flow to a cerebral hemisphere, the magnitude of the cerebral desaturation suggests that it is important to have a better understanding of the problem.…”

Section: Discussionmentioning

confidence: 99%

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Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

Brinkman

Amadeo

Funk

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Cerebral desaturation occurs frequently in patients undergoing one-lung ventilation for thoracic surgery. The mechanism of this desaturation is unclear regarding its etiology. The objective of this study was to investigate whether or not decreases in cerebral oxygen saturation associated with one-lung ventilation were a consequence of decreased cardiac output. Methods A blinded observational study was conducted in 23 patients undergoing one-lung ventilation with thoracic surgery. Eighteen patients completed the study. Cerebral oxygen saturation was monitored using near-infrared spectroscopy (FORE-SIGHT Ò monitor). Invasive blood pressure was monitored and hemodynamic variables were interrogated using the FloTrac Ò system. Anesthesia was maintained with sevoflurane with a F I O 2 of 1.0. Post-hoc analysis involved a comparison between baseline and integrated changes in cerebral saturation, heart rate, stroke index, cardiac index, and stroke volume variability. Results All patients showed cerebral desaturation from a baseline of two-lung ventilation in the lateral decubitus position following institution of one-lung ventilation. The cardiac index was stable at these times, but with one-lung ventilation, the heart rate decreased and the stroke index increased to maintain a stable product. The integral of heart rate 9 time was inversely correlated with the integral of cerebral desaturation 9 time (linear regression analysis; P = 0.02; (df) = 16)). Conclusions Cerebral oxygen desaturation was universal during one-lung ventilation in this study. There was no correlation between cerebral desaturation and cardiac output or other hemodynamic variables.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

Brinkman

Amadeo

Funk

et al. 2013

Can J Anesth/J Can Anesth

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“…A 20-G catheter was placed in the radial artery for obtaining blood gas analysis and monitoring invasive arterial blood pressure (ABP). Adhesive electrodes oximetry (INVOS TM Cerebral/ Somatic Oximeter, Somanetics TM , Troy, MI, USA) [5] for monitoring the regional cerebral oxygenation were stuck symmetrically on the forehead, high above the eyebrows to avoid positioning over sinus cavities. Patients were then placed in a prone position on a Jackson surgical table and the procedure was performed under general anesthesia in the usual fashion [6].…”

Section: Methodsmentioning

confidence: 99%

Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty

et al. 2012

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Purpose The purpose of this study is to evaluate the effects of multilevel balloon kyphoplasty (BK) on blood pressure, blood gases and cement leakage. Methods This is a prospective study of 63 patients: 31 were treated for osteoporotic vertebral compressive fractures (OVCF) and 32 for osteolytic tumors (OT). Twentysix patients were treated at 1 level, 15 at 2, 2 at 3, 6 at 4, 3 at 5, 4 at 6, 5 at 7 and 2 at 8. PPMA was used in 43 patients and calcium phosphate in 20. All patients were treated under general anesthesia with continuous invasive monitoring of hemodynamic changes, arterial blood gases and peripheral and regional cerebral oxygen saturation.Results Two patients had a transient drop in blood pressure between 21 and 42 % during simultaneous inflation of all four balloons at two levels and three more patients during cement injection (two PMMA, one calcium phosphate). Five patients had a cement leak (7.9 %), which was unrelated to the cement type or number of levels. Blood pressure, end-tidal carbon dioxide partial pressure and arterial oxygen partial pressure decreased statistically, but without any clinical significance after cement insertion. Peripheral and regional cerebral oxygen saturation remained unchanged. One-way ANOVA revealed no difference between these changes when clustered by the groups single level, two levels and three or more levels. Conclusion BK performed under general anesthesia appears to be safe when applied in multiple levels in the same seating provided the balloons are inflated sequentially and not simultaneously and the cement is inserted slowly in a very doughy state. Close monitoring of cardiorespiratory factors is valuable. Its rare circulatory effects are unrelated to the number of levels or the cement type.

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“…The review by Murkin and Arango 12 suggests that a [ 12% decrease in cerebral saturation is ''a reliable, sensitive, and relatively specific threshold for brain ischemia secondary to internal carotid artery clamping''. Our work suggests that the Fore-Sight cerebral oximeter may provide very early notification of intraoperative cerebral compromise as assessed by a large SctO 2 difference following cross-clamping of the carotid artery.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies have been both positive and negative regarding the value of cerebral oximetry to aid management during CEA (see reviews). 12,13 A newer cerebral oximeter -the Fore-Sight monitor is now commercially available. This monitor is deemed to be superior to devices previously available and claims to be an absolute measure of cerebral oxygenation.…”

Section: Résumémentioning

confidence: 99%

Lactate flux during carotid endarterectomy under general anesthesia: correlation with various point-of-care monitors

Espenell

McIntyre

Gulati

et al. 2010

Can J Anesth/J Can Anesth

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Purpose The ability to assess the brain-at-risk during carotid endarterectomy (CEA) under general anesthesia remains a major clinical problem. Point-of-care monitoring can potentially dictate changes to management intraoperatively. In this observational study, we examined the correlation between a series of point-of-care monitors and lactate flux during CEA. Methods Both neurosurgeons and vascular surgeons participated in the study. The patients underwent arterialjugular venous blood sampling for oxygen, carbon dioxide, glucose, and lactate, n = 26; bispectral index (BIS) monitoring ipsilateral to side of surgery, n = 26; raw and processed electroencephalogram (EEG), n = 22; and bi-frontal cerebral oximetry using the Fore-Sight monitor, n = 20. Results One patient experienced a new neurological deficit when assessed at 24 hr following surgery. Lactate flux into the brain was correlated with the greatest decrease in cerebral oximetry with carotid cross-clamping; lactate efflux was correlated with the least. The most noticeable changes in processed EEG (density spectral analysis) were also seen with lactate influx, but at a slower time resolution than cerebral oximetry. Loss of autoregulatory behaviour was demonstrated with lactate influx; however, no correlation was seen between lactate flux and BIS monitoring. Conclusion There was a correlation between cerebral oximetry and lactate flux during carotid cross-clamping. The Fore-Sight monitor may be of value as a point-of-care monitor during CEA under general anesthesia. A novel finding of this study is lactate flux into the brain in the presence of a large difference in cerebral oxygenation during cross-clamping of the carotid artery. Registered at clinicaltrials.gov: NCT000737334. RésuméObjectif La capacite´d'e´valuer le cerveau a`risque pendant une endarte´riectomie carotidienne (EC) sous anesthe´sie ge´ne´rale demeure un proble`me clinique important. Le monitorage au chevet pourrait potentiellement conduire ad es modifications de la prise en charge perope´ratoire. Dans cette e´tude observationnelle, nous avons explore´la corre´lation entre une se´rie de moniteurs au chevet et le flux de lactate pendant une EC. Méthode Des neurochirurgiens et des chirurgiens vasculaires ont pris part a`cette e´tude. Les patients ont subi un e´chantillonnage du sang veineux arte´riel jugulaire pour de´tecter les concentrations d'oxyge`ne, de dioxyde de carbone, de glucose et de lactate, n = 26; monitorage par index bispectral (BIS) ipsilate´ral au côte´de la chirurgie, n = 26; e´lectroence´phalogramme (EEG) brut et apre`s

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Near-infrared spectroscopy as an index of brain and tissue oxygenation

Cited by 738 publications

References 86 publications

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty

Lactate flux during carotid endarterectomy under general anesthesia: correlation with various point-of-care monitors

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