A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy

Rigamonti, Andrea; Scandroglio, Mara; Minicucci, Francesco; Magrin, S.; Carozzo, Andrea; Casati, Andrea

doi:10.1016/j.jclinane.2004.09.007

Cited by 124 publications

(67 citation statements)

References 24 publications

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“…This threshold is standard in the international literature and is based on the fact that in conscious patients, a 20% reduction in frontal lobe oxygenation is associated with clinical manifestations of cerebral hypoperfusion such as syncope [20,30]. Additionally, 20% or greater reduction in rSO 2 during carotid clamping test is associated with a 20-fold increase in developing overt signs and symptoms of cerebral ischemia during carotid endarterectomy [28].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

Salazar

Sears

Andre

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Patients undergoing arthroscopic shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications as a result of cerebral ischemia. Questions/purposes We sought to define the (1) incidence; (2) timing; and (3) magnitude of intraoperative cerebral desaturation events (CDEs) in subjects undergoing arthroscopic shoulder surgery in the beach chair position, as well as whether (4) the length of surgery was an independent risk factor for intraoperative CDEs. Methods Regional cerebral tissue oxygen saturation (rSO 2 ) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. Intraoperative decreases in rSO 2 of 20% or greater were defined as CDEs. Results The incidence of intraoperative CDEs in our series was 18% (nine of 51). Among the patients demonstrating CDE (n = 9), the mean time to onset of initial CDE was 18 minutes 38 seconds postinduction. Of those experiencing CDEs, the mean maximal decrease in rSO 2 was 32% from preoperative baseline per patient. Additionally, the mean number of separate CDE instances was 1.89 in this patient population with an average duration of 3 minutes 3 seconds per instance. There was no statistically significant difference (p = 0.202) between patients demonstrating CDEs and those without in regard to length of surgery (95 versus 88 minutes). Conclusions The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with near-infrared spectroscopy allows prompt identification and treatment of decreased cerebral perfusion. We believe protocols aimed at detecting and reversing CDE may improve patient safety. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

Salazar

Sears

Andre

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…14,36 -41 Although a number of authors have compared NIRS with other techniques such as jugular bulb oxygen saturation (SjO 2 ), transcranial Doppler ultrasonography and somatosensory-evoked potential 15,37,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] or with neurologic events, few have attempted to define an absolute threshold for ischemia. 13,14,16,17,46,[57][58][59] Most studies of this type using NIRS make no attempt to correct for extracranial contributions to signal changes. Of those who have tried to identify a threshold, the results show a low sensitivity and specificity.…”

mentioning

confidence: 99%

Tissue Oxygen Index

Al-Rawi

Kirkpatrick

2006

Stroke

151

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Background and Purpose-To date, the clinical application of near infrared spectroscopy in the adult brain has been limited. The NIRO 300 (Hamamatsu Photonics) provides a continuous measurement of tissue oxygen index (TOI) using spatially resolved spectroscopy. Although TOI reflects cerebral oxygenation to a high degree of sensitivity and specificity, to become a useful clinical tool, thresholds for cerebral ischemia need to be defined. This study has attempted to identify a quantifiable TOI threshold for ischemia in the adult brain. Methods-One hundred sixty-seven patients undergoing carotid endarterectomy were studied. The NIRO 300 was incorporated into an established multimodal monitoring system enabling observations of cerebral hemodynamic changes under highly controlled conditions. Changes in TOI (%⌬TOI) on clamping the internal carotid artery were compared with intracranial blood flow (middle cerebral artery flow velocity) and cerebral function monitoring to identify and quantify periods of cerebral ischemia. Results-Significant correlation was seen between changes in middle cerebral artery flow velocity and ⌬TOI on clamping (rϭ0.74, Pϭ0.0001). Thirty-one patients showed cerebral ischemia on internal carotid artery clamping as defined by a sustained fall in cerebral function monitoring. A threshold for %⌬TOI of Ϫ13 was identified, above which no patients showed any evidence of ischemia on clamping. This threshold provided 100% sensitivity and 93.2% specificity for patients satisfying the preset criteria for cerebral ischemia. Conclusions-These data demonstrate the potential to identify TOI-quantified thresholds for cerebral ischemia in the adult brain and thus improve the clinical use of near infrared spectroscopy. Our observations have defined a drop in TOI (13%) that can be adopted as a threshold for severe cerebral ischemia with high sensitivity and specificity. Key Words: carotid endarterectomy Ⅲ cerebral ischemia Ⅲ near infrared spectroscopy Ⅲ spatially resolved spectroscopy Ⅲ tissue oxygen index O ptical methods based on near-infrared spectroscopy (NIRS) can be used to monitor hemodynamic variables in the clinical setting. 1 Applications include monitors of fetal physiology, 2-4 during cardiac surgery, 5,6 muscle function, 7-10 and neonatal, 11 pediatric, 12 and adult brain. [13][14][15][16][17][18][19] A number of NIRS instruments are now available that detect changes in optical attenuation from several wavelengths of light, and although a variety of algorithms have been applied to attempt quantification, accuracy of these instruments remains a concern.The NIRO 300 (Hamamatsu Photonics) provides a continuous online measurement of tissue oxygen index (TOI) using spatially resolved spectroscopy. 20,21 We have previously determined that TOI reflects cerebral oxygenation to a high degree of sensitivity and specificity during carotid surgery, 20 an indication that NIRS can show clinically relevant estimations of cerebral hemodynamic and oxygen changes in the adult head (Figure 1). However, there are no da...

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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].…”

Section: Near Infrared Spectroscopy (Nirs)mentioning

confidence: 92%

“…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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A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy

Cited by 124 publications

References 24 publications

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

Tissue Oxygen Index

Carotid Stenosis and Anaesthesia

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