The Effect of Hemodynamic Parameters on Cerebral Oxygenization During Carotid Endarterectomy

Yücel, Cihan; Ketenciler, Serkan; Gürsoy, Mete; Türkmen, Seray; Kayalar, Nihan

doi:10.21470/1678-9741-2020-0398

Cited by 2 publications

(4 citation statements)

References 14 publications

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“…The latter proved to be feasible, as highlighted by the absence of protocol violations, and resulted in a clear biological effect indicated by significantly different arterial blood pressures and norepinephrine dosages between the two groups. Although other neuromonitoring tools have been used to detect cerebral hypoperfusion during CEA [14,29,30], we used a NIRS-guided protocol because NIRS is a validated and widely available neuromonitoring technique, easy to use, and can be interpreted without specific training in neurophysiology [6,[14][15][16][17]31]. A systematic review and meta-analysis concluded that NIRS has a low sensitivity, but high specificity to identify intraoperative ischemia compared with awake monitoring in patients undergoing CEA [32].…”

Section: Discussionmentioning

confidence: 99%

“…Near-infrared spectroscopy (NIRS) has been introduced as a neuromonitoring tool during carotid artery surgery to track cerebral oxygenation, detect cerebral hypoperfusion [6,14,15], and guide selective shunting [16]. Arterial blood pressure and regional brain tissue oxygenation as measured using NIRS were found to be closely correlated during carotid cross-clamping in patients undergoing CEA [17]. An absolute decrease in regional brain tissue oxygen saturation by 10-20% has been suggested to reflect critical cerebral hypoperfusion [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

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Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial

Mahečić

Malojčić

Tonković

et al. 2023

JCM

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Background: Differences in blood pressure can influence the risk of brain ischemia, perioperative complications, and postoperative neurocognitive function in patients undergoing carotid endarterectomy (CEA). Methods: In this single-center trial, patients scheduled for CEA under general anesthesia were randomized into an intervention group receiving near-infrared spectroscopy (NIRS)-guided blood pressure management during carotid cross-clamping and a control group receiving standard care. The primary endpoint was postoperative neurocognitive function assessed before surgery, on postoperative days 1 and 7, and eight weeks after surgery. Perioperative complications and cerebral autoregulatory capacity were secondary endpoints. Results: Systolic blood pressure (p < 0.001) and norepinephrine doses (89 (54–122) vs. 147 (116–242) µg; p < 0.001) during carotid cross-clamping were lower in the intervention group. No group differences in postoperative neurocognitive function were observed. The rate of perioperative complications was lower in the intervention group than in the control group (3.3 vs. 26.7%, p = 0.03). The breath-holding index did not differ between groups. Conclusions: Postoperative neurocognitive function was comparable between CEA patients undergoing general anesthesia in whom arterial blood pressure during carotid cross-clamping was guided using NIRS and subjects receiving standard care. NIRS-guided, individualized arterial blood pressure management resulted in less vasopressor exposition and a lower rate of perioperative complications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial

Mahečić

Malojčić

Tonković

et al. 2023

JCM

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“…Furthermore, higher blood pressure results in better perfusion (concluded from P(j-a)CO 2 ) through the entire period of the carotid artery clamp. It has been a long-time recommendation to keep blood pressure elevated during CEA [ 14 , 15 , 50 ]. Our observations support these suggestions.…”

Section: Discussionmentioning

confidence: 99%

“…To adequately monitor cerebral function, CEA is often performed in regional anesthesia, most frequently by cervical plexus block [ 10 ]. Besides the general advantages [ 11 ], operating on awake patients offers hemodynamic benefits, e.g., fewer hypotensive episodes, and thus less vasopressor usage, and consequently better cerebral perfusion [ 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Cerebral and Systemic Stress Parameters in Correlation with Jugulo-Arterial CO2 Gap as a Marker of Cerebral Perfusion during Carotid Endarterectomy

Kovács-Ábrahám

Aczél

Jancsó

et al. 2021

JCM

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Intraoperative stress is common to patients undergoing carotid endarterectomy (CEA); thus, impaired oxygen and metabolic balance may appear. In this study, we aimed to identify new markers of intraoperative cerebral ischemia, with predictive value on postoperative complications during CEA, performed in regional anesthesia. A total of 54 patients with significant carotid stenosis were recruited and submitted to CEA. Jugular and arterial blood samples were taken four times during operation, to measure the jugulo-arterial carbon dioxide partial pressure difference (P(j-a)CO2), and cortisol, S100B, L-arginine, and lactate levels. A positive correlation was found between preoperative cortisol levels and all S100B concentrations. In addition, they are positively correlated with P(j-a)CO2 values. Conversely, postoperative cortisol inversely correlates with P(j-a)CO2 and postoperative S100B values. A negative correlation was observed between maximum systolic and pulse pressures and P(j-a)CO2 after carotid clamp and before the release of clamp. Our data suggest that preoperative cortisol, S100B, L-arginine reflect patients’ frailty, while these parameters postoperatively are influenced by intraoperative stress and injury. As a novelty, P(j-a)CO2 might be an emerging indicator of cerebral blood flow during CEA.

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The Effect of Hemodynamic Parameters on Cerebral Oxygenization During Carotid Endarterectomy

Cited by 2 publications

References 14 publications

Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial

Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under General Anesthesia: A Randomized, Controlled Trial

Cerebral and Systemic Stress Parameters in Correlation with Jugulo-Arterial CO2 Gap as a Marker of Cerebral Perfusion during Carotid Endarterectomy

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