Cerebral near-infrared spectroscopy (NIRS) for perioperative monitoring of brain oxygenation in children and adults

Abstract

The effects of perioperative active cerebral NIRS monitoring of brain oxygenation in adults for reducing the occurrence of short-term, mild POCD are uncertain due to the low quality of the evidence. There is uncertainty as to whether active cerebral NIRS monitoring has an important effect on postoperative stroke, delirium or death because of the low number of events and wide confidence intervals. The conclusions of this review may change when the eight ongoing studies are published and the 12 studies awaiting assessment are classified. More RCTs performed in the paediatric population and high-risk patients undergoing non-cardiac surgery (e.g. neurosurgery, carotid endarterectomy and other surgery) are needed.

Is cerebral monitoring useful? Focus must shift from mere observation to testing interventions

“…Despite optimism for utility of NIRS and TCD as non-invasive assessment tools for cerebral well-being, the evidence to support treatment decisions based on these measures remains sparse. 4,5 Chaix et al report in this journal that high cardiovascular risk patients are prone to a larger reduction in mean blood velocity in the middle cerebral artery (MCAv mean ) during induction of anaesthesia compared to low-risk patients. 6 A reduction similar to that when awake patients with sympathetic failure and orthostatic symptoms go from supine to standing position without immediate syncope.…”

Neurologic outcomes after heart surgery

“…A recent Cochrane Review looked at cerebral NIRS for perioperative monitoring of brain oxygenation and found that perioperative NIRS monitoring had an uncertain effect on reducing short-term, mild postoperative cognitive decline due to low quality of evidence 42 .…”

Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study

“…One could speculate that measurement errors may appear because of the position of the head (neck extension), movement of the head, surgical manipulation of the head, light from the environment (eg, operation lamp), poor sensor attachment and other unknown measurement errors. 5,17 One could also speculate that the high inspired oxygen during preoxygenation and sevoflurane may have quantitatively different regional effects on cerebral oxygenation. 10,17,18…”

“…2 Although the popularity of NIRS monitoring is growing, definitive data that prove outcome benefits with its use remain sparse. 2,3,5 In addition, another risk area which also is closely investigated is the brain response to anesthesia exposure early in life.…”

“…In a recent systematic review on the use of NIRS for perioperative monitoring of brain oxygenation in adults and children, Yu et al 5 identified 15randomized controlled trials in this field. Their finding was that there was an uncertainty as to whether cerebral NIRS has an important effect on postoperative stroke, delirium, death or cognitive dysfunction However, none of these trials included children and the authors concluded that randomized controlled trials in a pediatric population are needed before it can be recommended as a monitoring device 5. In a study of method comparison, assessment of within-method error is important, because the error of each of two methodsF I G U R E 1 Shows four patients, where frontal and occipital recordings of rScO 2 changed in parallel during the surgical procedure.…”