Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: comparative evaluation

Tambakis, Charalambos L; Papadopoulos, George Α.; Sergentanis, Theodoros N.; Lagos, Nikolaos; Αrnaoutoglou, Eleni; Labropoulos, Nicos; Matsagkas, Miltiadis

doi:10.1258/vasc.2010.oa0277

Cited by 20 publications

(9 citation statements)

References 31 publications

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“…Similarly, rScO 2 correlates to SjvO 2 (Williams et al, 1994b; Grubhofer et al, 1997; Espenell et al, 2010) and a correlation to stump pressure is also reported (Kragsterman et al, 2004; Yamamoto et al, 2007; Lee et al, 2008; Manwaring et al, 2010; Tambakis et al, 2011) so that a low stump (<40 mmHg) results in a large change in rScO 2 (Tambakis et al, 2011) but the relationship might be absent in a large series of patients (Pedrini et al, 2012). rScO 2 and systemic blood pressure correlate, with higher pressures leading to better oxygenation values (Williams et al, 1994c; Ritter et al, 2011).…”

Section: Resultsmentioning

confidence: 90%

“…Especially patients with rScO 2 drop >20% require shunting (Ritter et al, 2011; Stilo et al, 2012) and NIRS has a sensitivity of ≈75% and specificity ≈98% of the need for shunting (Ali et al, 2011; Ritter et al, 2011). The criterion for establishing a shunt is (i) a 20% drop in ipsilateral rScO 2 from baseline (Zogogiannis et al, 2011) or (ii) a change in rScO 2 greater than 25% or a delta rScO 2 greater than 20% that is not improved within 3 min by increasing blood pressure (Pedrini et al, 2012), or (iii) a cut-off of 21 or 10% reduction from the baseline (Tambakis et al, 2011). In patients operated under cover of local anesthesia (LA), it is the awake testing procedure that determines when a shunt is needed (Stilo et al, 2012).…”

Section: Resultsmentioning

confidence: 99%

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

Nielsen

2014

Front. Physiol.

124

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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: 90%

Section: Resultsmentioning

confidence: 99%

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

Nielsen

2014

Front. Physiol.

124

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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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“…As the recorded reading of the back pressure in the targeted artery, the need for shunting was decided. [ 15 16 ] Stump pressure values >25 mmHg shows the safe level as it was thought in the past years, later it was revised to mean of 40 mmHg as the safe level. [ 17 18 ] On the contrary, different studies recorded few patients had consciousness impairment (shunt requirement) even when stump pressure was giving records reach to 50 mmHg and greater, plus the technique showed some percentage of unnecessary need for shunt records in different clinical studies.…”

Section: Ethodologymentioning

confidence: 99%

Anesthetic considerations for carotid endarterectomy: A postgraduate educational review

Sultan

Alsubhi

2018

Anesth Essays Res

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Carotid endarterectomy (CEA) has shown a significant benefit in preventing ipsilateral stroke when it is compared to conservative management. Surgical morbidity and mortality must be kept to a minimum to achieve this benefit. Neurological status of the CEA patients can be monitored easily during regional anesthesia depending on the awake testing (neurocognitive assessment) method of the CEA patients. In addition, specific parameters can help us to monitor and to predict the neurological status of the CEA patients during the procedures such as regional cerebral oxygen saturation (rSO2) and middle cerebral artery velocity (MCAv) changes. We conducted a computerized literature search involving humans, published in English until December 2017, and indexed through Medical Databases; MEDLINE/PubMed, EMBASE, and Web of Science. We reviewed articles performed for prospective and other types of studies related to CEA procedures and techniques which can predict patient's status during the procedure. Searching relevant articles and discussing the results to allow meaningful rate comparison, and to conclude a result view which benefits the CEA patients and the medical staff during the CEA procedures. In total, studies observed cerebral rSO2 and MCAv have significant value during CEA procedures. Patients with neurological symptoms during the procedures showed changes of cerebral rSO2 and MCAv more than the patients without neurological symptoms. Mentioned parameters (cerebral rSO2 and MCAv) showed significant increasing right after the procedure. Mostly, CEA surgeries under local anesthesia were observed, for monitoring patients’ consciousness status and comparing it to patients who undergo general anesthesia, to view the reliability of these techniques during CEA procedures, and to predict and avoid intraoperative neurological symptoms.

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Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: comparative evaluation

Cited by 20 publications

References 31 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

Anesthetic considerations for carotid endarterectomy: A postgraduate educational review

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