The Value of Cerebral Oximetry Monitoring in Cardiac Surgery: Challenges and Solutions in Adult and Pediatric Practice

Frogel, Jonathan; Kogan, Alexander; Augoustides, John; Berkenstadt, Haim; Feduska, Eric; Steyn, Johannes; Dwarakanath, Sanjay; Nir, Eshel A.; Stohl, Sheldon

doi:10.1053/j.jvca.2018.08.206

Cited by 8 publications

(7 citation statements)

References 74 publications

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“…Regional cerebral oxygenation may be non-invasively monitored using near-infrared spectroscopy (NIRS). This involves attaching probes, one transmitter and two sensors, onto the skin of the patients’ forehead ( 100 ). One sensor detects the absorption of infrared light from superficial tissue, whilst the other detects infrared light from deeper tissue ( 100 ).…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

“…This involves attaching probes, one transmitter and two sensors, onto the skin of the patients’ forehead ( 100 ). One sensor detects the absorption of infrared light from superficial tissue, whilst the other detects infrared light from deeper tissue ( 100 ). Subsequently, the transmitter emits infrared light, which is absorbed by haemoglobin.…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

“…This is particularly important in the elderly, as cognitive function naturally declines with age and cardiac surgery may exacerbate this cognitive decline ( 49 , 90 , 115 ). Interventions have included increasing inspired oxygen concentration, altering carbon dioxide levels, increasing mean arterial pressure, and increasing anaesthesia ( 100 ). Additionally, the positioning of the NIRS probes over watershed areas such as the anterior and middle cerebral arteries may prevent watershed strokes ( 116 , 117 ).…”

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

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An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015–present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyse the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs. intravenous anaesthesia, and the efficacy of dexmedetomidine.

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Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

Section: Pathophysiology Of Postoperative Cognitive Dysfunction Follo...mentioning

confidence: 99%

See 1 more Smart Citation

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Smith

2022

Front. Psychiatry

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“…Regional cerebral oxygenation may be noninvasively monitored using near-infrared spectroscopy (NIRS). This involves attaching probes, one transmitter and two sensors, onto the skin of the patients' forehead [97]. One sensor detects the absorption of infrared light from superficial tissue, whilst the other detects infrared light from deeper tissue [97].…”

Section: Monitoring Of Cerebral Perfusion Via Near-infrared Spectroscopymentioning

confidence: 99%

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Vu¹,

Smith²

2022

Which Factors Contribute to Innovative Performance? A Case Study Applied to the Food and Beverage Industry

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Postoperative cognitive dysfunction is extremely prevalent following cardiac surgery. The increasing patient age and comorbidity profile increases their susceptibility to cognitive impairment. The underlying pathophysiological mechanisms leading to cognitive impairment are not clearly elucidated. Using the contemporary literature (2015present), this narrative review has three aims. Firstly, to provide an overview of postoperative cognitive impairment. Secondly, to analyze the predominant pathophysiological mechanisms leading to cognitive dysfunction following cardiac surgery such as inflammation, cerebral hypoperfusion, cerebral microemboli, glycaemic control and anaesthesia induced neurotoxicity. Lastly, to assess the current therapeutic strategies of interest to address these pathophysiological mechanisms, including the administration of dexamethasone, the prevention of prolonged cerebral desaturations and the monitoring of cerebral perfusion using near-infrared spectroscopy, surgical management strategies to reduce the neurological effects of microemboli, intraoperative glycaemic control strategies, the effect of volatile vs intravenous anaesthesia, and the efficacy of dexmedetomidine.

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“…This method is not affected by nonpulsatile blood flow, low temperature, or other factors, and it has been extensively applied in anesthesia for cardiac surgery (8). Frogel et al (9) believed that monitoring cerebral oxygen saturation during cardiac surgery can indirectly reflect the status of brain tissue perfusion, and effective monitoring can guide the implementation of intraoperative brain protection measures. rSO 2 monitoring can effectively prevent cardiac surgeryrelated POCD, since insufficient brain oxygen supply during surgery is one of the causes of POCD (10,11).…”

Section: Comparison Of Mmse Scores At Each Time Point Between the Two Groupsmentioning

confidence: 99%

Impact of permissive hypercapnia on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing cardiac valve replacement

Zhu¹,

Shi²,

Zhu³

et al. 2020

Ann Palliat Med

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Background: Cardiac valve replacement (CVR) is currently the main surgical treatment for patients with valvular heart diseases (VHD). Postoperative cognitive dysfunction (POCD) is one of the most serious complications of cardiac surgery.. Permissive hypercapnia (PHC), an important lung-protective ventilation strategy, has protective effects on vital organs, including the heart, lungs, and central nervous system (CNS). The main objective of this study is to assess the effect of the PHC ventilation strategy on rSO 2 and postoperative cognitive function in patients undergoing CVR.Methods: A total of 66 patients undergoing CVR were included and randomly divided into the PHC ventilation group (Group H, n=33) and conventional ventilation group (Group C, n=33). Patients of both groups were subjected to conventional ventilation before cardiopulmonary bypass (CPB). patients in Group H were subjected to the PHC ventilation strategy to keep the partial pressure of carbon dioxide (PaCO 2 ) at 46-60 mmHg.Results: (I) Group H had a lower HR at T0 and T1 (P<0.05) and higher CO at T3 and T4 (P<0.05) than Group C. (II) Group H had higher rSO 2 at T4 (P<0.05), lower pH and lactate (Lac) at T4 (P<0.05), higher PaCO 2 at T3 and T4 (P<0.05), and lower PaO 2 at T3 and T4 (P<0.05). (III) Compared to 1 d before surgery, the MMSE scores of both groups were lower 24 h after surgery (P<0.05).Conclusions: PHC can increase the rSO 2 of patients undergoing CVR, increase cerebral blood flow, improve the cerebral oxygen supply/consumption balance, and play a protective role in the brain. It has no significant impact on the incidence of POCD.

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The Value of Cerebral Oximetry Monitoring in Cardiac Surgery: Challenges and Solutions in Adult and Pediatric Practice

Cited by 8 publications

References 74 publications

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

An Update on Postoperative Cognitive Dysfunction Following Cardiac Surgery

Impact of permissive hypercapnia on regional cerebral oxygen saturation and postoperative cognitive function in patients undergoing cardiac valve replacement

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