The role of somatosensory evoked potentials in detecting cerebral ischaemia during carotid endarterectomy

Abstract

Compared to other studies, we have shown a much lower sensitivity and specificity of somatosensory evoked potentials in detecting critical cerebral perfusion; thus its use remains controversial and has to be assessed in further investigations.

Practice advisory on the bleeding risks for peripheral nerve and interfascial plane blockade: evidence review and expert consensus

“…These include blood vessels such as the vertebral artery, dorsal scapular artery, and suprascapular artery. There are reports of direct injection of local anesthetic into the vertebral artery [18][19][20] and subarachnoid space 20,21 during deep cervical plexus blocks. Bleeding from these deeper vessels may be occult, difficult to tamponade noninvasively, and the mass effect from an expanding hematoma in the neck could have significant consequences.…”

AVC périopératoire

“…72, 73 EEG, however, may allow for faster and more sensitive detection of ischemia as compared to SSEP in these cases. 72, 74 A review of these techniques, as well as a discussion of their respective benefits and drawbacks, can be found elsewhere. 74–76 Assessment of regional cerebral oxygenation (rSO 2 ) is an additional intraoperative neuromonitoring technique, where near-infrared spectroscopy (NIRS) is used to indirectly measure cerebral tissue oxygenation.…”

“…72, 74 A review of these techniques, as well as a discussion of their respective benefits and drawbacks, can be found elsewhere. 74–76 Assessment of regional cerebral oxygenation (rSO 2 ) is an additional intraoperative neuromonitoring technique, where near-infrared spectroscopy (NIRS) is used to indirectly measure cerebral tissue oxygenation. 77, 78 In cardiac surgery patients, preliminary data indicate that intraoperative rSO 2 monitoring may reduce perioperative stroke risk, 79, 80 though further studies are needed to confirm or refute these findings.…”

Shunting during carotid endarterectomy

“…The optimal method for evaluating cerebral perfusion during CEA and to determine the need for selective shunting is also controversial. In patients undergoing CEA under general anesthesia, several investigators prefer electroencephalogram (EEG) monitoring, [22][23][24][25][26][27][28][29] while others prefer transcranial Doppler (TCD), [30][31][32][33][34][35] carotid stump pressure (SP) measurements, 14,[36][37][38][39][40][41][42][43][44][45] somatosensory evoked potential (SSEP), [46][47][48][49][50][51][52][53][54][55] or cerebral oximetry monitoring 56,57 to determine the need for shunting. Meanwhile, for patients undergoing CEA with regional anesthesia, selective shunting can be based on alterations in the neurological examination that develop after carotid clamping.…”