The Role of Cerebral Oximetry in Combination with Awake Testing in Patients Undergoing Carotid Endarterectomy under Local Anaesthesia

Ritter, Jens Carsten; Green, D.; Slim, Hani; Tiwari, Alok; Brown, John W.; Rashid, Hisham

doi:10.1016/j.ejvs.2010.12.009

Cited by 55 publications

(40 citation statements)

References 38 publications

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“…Several report rScO 2 during carotid surgery (Williams et al, 1994a,b,c, 1999; Duncan et al, 1995; Kuroda et al, 1996a; Mead et al, 1996; Samra et al, 1996; Duffy et al, 1997; Beese et al, 1998; Carlin et al, 1998; de Letter et al, 1998; Fearn et al, 2000; Takeda et al, 2000; Kawada et al, 2002; Cuadra et al, 2003; Ogasawara et al, 2003; Vets et al, 2004; Komoribayashi et al, 2006; Yamamoto et al, 2007; Ishigaki et al, 2008; Lee et al, 2008; Stoneham et al, 2008; Kobayashi et al, 2009; Giustiniano et al, 2010; Moritz et al, 2010; Ali et al, 2011; Ritter et al, 2011; Pedrini et al, 2012; Uchino et al, 2012). …”

Section: Resultsmentioning

confidence: 99%

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Nielsen

2014

Front. Physiol.

119

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Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation (rScO2) during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed (i) to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and (ii) to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparoscopic surgery with the patient placed in anti-Tredelenburg's position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery (ICA) also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic, and abdominal surgery the occurrence of postoperative cognitive dysfunction (POCD) might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of rScO2. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.

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Section: Resultsmentioning

confidence: 99%

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Nielsen

2014

Front. Physiol.

119

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“…A cut off ≥19% drop in regional oxygen saturation has a high sensitivity and specificity when compared with awake testing (17). Another study identified a cut-off of 21 and 10.1% reduction from the baseline as optimal when deciding whether patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively (18).…”

Section: Discussionmentioning

confidence: 99%

Noninvasive cerebral oximetry during carotid endarterectomy: application and results

Kontrimavičiūtė¹,

Kuzminskaitė²,

Šipylaitė³

2015

AML

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Background. Cerebral monitoring during carotid endarterectomy allows to detect brain hypoperfusion following carotid clamping and hyperperfusion after restoring the blood flow. Immediate corrections of these changes have the potential in reducing adverse neurologic outcomes. In this study we share our experience using cerebral oximetry in carotid endarterectomy surgery, as well as finding a connection between comorbidities and baseline cerebral oxygenation values.Materials and methods. A non-randomised perspective study was performed at Vilnius University Hospital Santariškių Clinics. During 2012-2013 all consecutive elective patients undergoing carotid surgery were enrolled in the study.Results. No difference was found in the baseline values on the operative and control sides (71.15% vs 76.76%, p = 0.15). After carotid clamping regional brain saturation decreased by 4.34% of the baseline on the operative side. During the clamping cerebral oxygenation was lower on the operative side (68.06% vs 77.32%, p = 0.03). Following carotid declamping the difference between operative and control side oxygenation diminished (73.57% vs 79.30%, p = 0.16). Neither diabetes nor peripheral atherosclerosis had influence on baseline cerebral oxygen saturation values. There was a tendency towards the lower cerebral oxygenation baseline for smokers (70.12% vs 76.54%, p = 0.103).Conclusions. Cerebral oximetry is a valuable method of cerebral monitoring reflecting changes in brain perfusion during carotid endarterectomy. Certain comorbidities might have a role in affecting baseline oximetry values.

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“…It has also shown its correlation with EEG changes, transcranial Doppler, carotid stump pressure and postoperative neurological deficits [29,[30][31][32][33]. The sensitivity of this test ranges from 30 to 100% according to various studies and its specificity between 77 and 98% [29,[30][31][32][33][34][35][36]. The limit value is not well established, although several studies suggest a decrease of 11.7-25% above baseline value [29,30,[34][35][36].…”

Section: Near Infrared Spectroscopy (Nirs)mentioning

confidence: 99%

“…The sensitivity of this test ranges from 30 to 100% according to various studies and its specificity between 77 and 98% [29,[30][31][32][33][34][35][36]. The limit value is not well established, although several studies suggest a decrease of 11.7-25% above baseline value [29,30,[34][35][36]. This method has the advantage of being non-invasive, continuous and easy to interpret but the fact of collecting information of the frontal lobe, behaves as a disadvantage as it leaves the parietal lobe unmonitored, being the most sensitive lobe to ischemia during carotid surgery [34].…”

Section: Near Infrared Spectroscopy (Nirs)mentioning

confidence: 99%

Carotid Stenosis and Anaesthesia

Jj¹,

A²,

Jl³

et al. 2016

Int J Surg Surgical Proced

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EpidemiologyThe importance of carotid stenosis approach lies in the relationship it has with ischemic stroke, since it is present in 10-20% of all of them. This is of magnitude when we know that in Western countries, stroke is the third leading cause of death, behind only heart disease and cancer, with a mortality ranging from 10 to 30%, having survivors risk of recurring ischemic cardiac or neurologic events, so much so that is the leading cause of disability. The prevalence of stenosis in the internal carotid artery (ICA) is high and furthermore increases with age, in fact more than 50% stenosis rises from 0.5% in people aged between 50 and 59 years to 10% in those over 80 years. The primary mechanism involved in stroke in patients with carotid stenosis is embolism of atherosclerotic or thrombotic waste material from the plate to the distal cerebral vasculature. Infiltration of inflammatory cells on the surface of carotid plaques can play a key role in causing plaque rupture and embolization or occlusion of the carotid and also hemodynamic factors are correlated with increased risk of stroke in patients with carotid stenosis [1,2,3]. Of all the factors studied, the degree of arterial stenosis has emerged as the most directly related to the increased risk of stroke. Any diagnostic strategy, whatever the technique used, should have as its primary objective to determine, in the most accurate way, the amount of this stenosis [4].In the NASCET study the risk of ipsilateral recurrent stroke in patients with symptomatic carotid stenosis treated conservatively was 4.4% per year for patients with stenosis between 50 and 69% and 13% per year for those with 70% stenosis. The risk in patients with asymptomatic stenosis of 60% was around 1-2%, but could rise to 3-4% per year in elderly patients or in the presence of stenosis or occlusion of the contralateral artery, evidence of silent embolization in an imaging test, heterogeneity of the carotid plaque, poor collateral circulation, generalized inflammatory state or peripheral or coronary artery disease associated [5]. Treatment Medical versus interventional treatmentGiven the above discussion, we will assume that the main objective in the treatment of carotid stenosis is the prevention of ischemic stroke and its aftermath, regardless of the type of patient, the presence or absence of symptoms and the degree of stenosis. However, despite the clarity of the target it is unclear what therapeutic option to choose among only medical treatment or revascularization and, in the latter case, between endoluminal or surgical treatment. We will be guided in this review [6], considering that these guidelines place more emphasis on stroke prevention in the prevention of ischemic heart disease, on the grounds that according to the CREST study, stroke has shown greater impact on quality of life of the patient than nonfatal myocardial ischemia [7].The major determinants of the clinical course are the presence or absence of neurological symptoms and the degree of stenosis. The threat of isc...

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The Role of Cerebral Oximetry in Combination with Awake Testing in Patients Undergoing Carotid Endarterectomy under Local Anaesthesia

Abstract: Cerebral oximetry using a cut off ≥19% drop in rSO(2) has a high sensitivity and specificity when compared with awake testing.

Cited by 55 publications

References 38 publications

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Noninvasive cerebral oximetry during carotid endarterectomy: application and results

Carotid Stenosis and Anaesthesia

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