Cerebral Oxygen Desaturation After Cardiopulmonary Bypass in a Patient with Raynaud's Phenomenon Detected by Near-Infrared Cerebral Oximetry

Aron, Jesse H.; Fink, Gregory W.; Swartz, Michael F.; Ford, Brant; Hauser, Michael C.; O’Leary, Colleen E.; Puskás, Ferenc

doi:10.1213/01.ane.0000260265.53212.fe

Cited by 10 publications

(7 citation statements)

References 5 publications

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“…In a patient with Raynaud's phenomenon, a bilateral drop in rSO 2 with concomitant loss of finger pulse oximetry was reversed with intravenous nitroglycerin after separation from CPB. 20 Likewise, other authors have shown that optimization of rSO 2 may help prevent hypoxic brain injury and reduce length of hospital stay in higher risk patients undergoing major abdominal surgery. 21 Reduction in rSO 2 also predicts postoperative cognitive dysfunction in thoracic surgery 22 and is a reliable indicator of clamping ischemia in carotid endarterectomy.…”

Section: Discussionmentioning

confidence: 98%

Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

Chan

Underwood

et al. 2014

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 98%

Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

Chan

Underwood

et al. 2014

Can J Anesth/J Can Anesth

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“…Our group has recently shown in our porcine model that controlled periods of hypoxia to a SpO 2 target of 70% lead to a TSI% decrease of 10.5 ± 1% as recorded by the PortaMon NIRS sensor from the animal's hindlimb 49 . While clinically, such www.nature.com/scientificreports/ severe episodes of hypoxia are unlikely to be encountered on a routine basis; other investigators have reported decreases in NIRS-derived tissue saturation indices in various clinical settings that lead to tissue hypoperfusion, including vascular disease 50 and shock [51][52][53] .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of transcutaneous near-infrared spectroscopy for early detection of cardiac arrest in an animal model

Raschdorf

Mohseni

Hogle

et al. 2023

Sci Rep

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Sudden cardiac arrest (SCA) is a leading cause of mortality worldwide. The SCA-to-resuscitation interval is a key determinant of patient outcomes, highlighting the clinical need for reliable and timely detection of SCA. Near-infrared spectroscopy (NIRS), a non-invasive optical technique, may have utility for this application. We investigated transcutaneous NIRS as a method to detect pentobarbital-induced changes during cardiac arrest in eight Yucatan miniature pigs. NIRS measurements during cardiac arrest were compared to invasively acquired carotid blood pressure and partial oxygen pressure (PO2) of spinal cord tissues. We observed statistically significant decreases in mean arterial pressure (MAP) 64.68 mmHg ± 13.08, p < 0.0001), spinal cord PO2 (38.16 mmHg ± 20.04, p = 0.0028), and NIRS-derived tissue oxygen saturation (TSI%) (14.50% ± 3.80, p < 0.0001) from baseline to 5 min after pentobarbital administration. Euthanasia-to-first change in hemodynamics for MAP and TSI (%) were similar [MAP (10.43 ± 4.73 s) vs TSI (%) (12.04 ± 1.85 s), p = 0.3714]. No significant difference was detected between NIRS and blood pressure-derived pulse rates during baseline periods (p > 0.99) and following pentobarbital administration (p = 0.97). Transcutaneous NIRS demonstrated the potential to identify rapid hemodynamic changes due to cardiac arrest in periods similar to invasive indices. We conclude that transcutaneous NIRS monitoring may present a novel, non-invasive approach for SCA detection, which warrants further investigation.

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“…22 Evidence of cerebral, not just skin, hypoperfusion associated with RD includes de novo recurrent infarctions in a patient with RD and migraine with aura 12 and of cerebral oxygen desaturation after cardiopulmonary bypass in a patient with RD. 23 Single-photon emission computed tomographic analysis showed deterioration in preexisting cerebral perfusion defects in patients with secondary RP subjected to a cold stress test. 24 Vasoconstriction in human microcirculation in subarachnoid hemorrhage 22 and focal arteriolar vasospasm in the retina of a patient with migraine 25 have been documented.…”

Section: Brainstem Ischemia Cerebral Vasospasm and Rpmentioning

confidence: 99%

Syncope and Raynaud’s Disease

Guiloff

Rajakulendran²,

Angus‐Leppan³

2012

Arch Neurol

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To investigate an association between syncope and Raynaud's disease (RD), its clinical features, and the effect of treatment with nifedipine. Design: One-year prospective study of new outpatients after 3 initial clinical observations. Setting: Neurology clinics at Chelsea and Westminster, Royal Free, Barnet, and Edgware Hospitals. Patients: Ten women and 1 man. The group had a mean (SD) age of 33 (17) years. Mean (SD) follow-up was 24 (36) months. Intervention: Treatment with nifedipine. Outcome Measures: Observed vs expected frequency of syncope in RD, temporal relation between syncope and Raynaud's phenomenon, clinical features, and response to nifedipine treatment. Results: Eight additional patients with syncope and RD were identified from 603 new patients (1.3%); we had expected only 1 patient to be identified with syncope and RD (P=.003). A chance association between RD and migraine with recurrent syncope was unlikely (P=.01). The prevalence of RD in patients with syncope with migraine was higher than expected (P=.03), but that of migraine in patients with RD was not (P = .2). All 11 patients had 5 or more syncopal episodes for a median of 2 years (range, 0.1-62 years). Three patients had previous diagnoses of nonepileptic attacks. Syncope was preceded by or contemporaneous with Raynaud's phenomenon in 10 patients (P = .02). Nine patients had migraine; headache was contemporaneous with syncope in 4 patients as expected by chance (P = 1.0). In all patients, syncope was preceded by brainstem or vertebrobasilar symptoms, and it ceased after treatment with nifedipine. Raynaud's disease and migraine improved less. Conclusions: The association of syncope to RD was unrelated to chance or migraine. The temporal relation between syncope and Raynaud's phenomenon but not headache was statistically significant. Treatment with nifedipine stopped recurrent syncope in all patients. Syncope related to RD may result from brainstem ischemia. Unexplained recurrent syncope should prompt screening for RD.

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Cerebral Oxygen Desaturation After Cardiopulmonary Bypass in a Patient with Raynaud's Phenomenon Detected by Near-Infrared Cerebral Oximetry

Cited by 10 publications

References 5 publications

Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

Evaluation of transcutaneous near-infrared spectroscopy for early detection of cardiac arrest in an animal model

Syncope and Raynaud’s Disease

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