Cerebral oxygenation monitoring using near infrared spectroscopy during controlled hypotension

Shear, Torin; Tobias, Joseph D.

doi:10.1111/j.1460-9592.2005.01495.x

Cited by 18 publications

(6 citation statements)

References 23 publications

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“…The effect of induced hypotension on cerebral blood flow and oxygenation has been investigated using Doppler ultrasonography 47,49,50,85 , infrared spectroscopy 82 , thermal gradient blood flow meter 6 , measurement of difference in oxygen content in arterial and venous blood samples 60,72 , clearance of intra-arterially injected xenon 133 60 and electroencephalography 82,179,186 . Most studies showed no decrease in cerebral blood flow during hypotensive anaesthesia 4-6,8, 23,24,50,82,85,94,107,116,131,142,163,181,184,186,199 and even if there were a statistically significant reduction there was no evidence of a long-term adverse outcome clinically. One study entered in the final review showed no significant difference in cognitive test scores between patients receiving normotensive and hypotensive anaesthesia 153 .…”

Section: Discussionmentioning

confidence: 99%

Risks and benefits of deliberate hypotension in anaesthesia: a systematic review

Choi¹,

Samman²

2008

International Journal of Oral and Maxillofacial Surgery

144

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Section: Discussionmentioning

confidence: 99%

Risks and benefits of deliberate hypotension in anaesthesia: a systematic review

Choi¹,

Samman²

2008

International Journal of Oral and Maxillofacial Surgery

144

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Section: Discussionmentioning

confidence: 99%

Changes in cerebral oxygenation based on intraoperative ventilation strategy

Dewhirst¹,

Walia²,

Samora³

et al. 2018

MDER

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IntroductionCerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO2) using near-infrared spectroscopy (NIRS). Changes in rSO2 have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation. The aim of this study was to evaluate the changes in rSO2 during intraoperative changes in mechanical ventilation.Patients and methodsFollowing the approval of the institutional review board (IRB), tissue and cerebral oxygenation were monitored intraoperatively using NIRS. Prior to anesthetic induction, the NIRS monitor was placed on the forehead and over the deltoid muscle to obtain baseline values. NIRS measurements were recorded each minute over a 5-min period during general anesthesia at four phases of ventilation: 1) normocarbia (35–40 mmHg) with a low fraction of inspired oxygen (FiO2) of 0.3; 2) hypocarbia (25–30 mmHg) and low FiO2 of 0.3; 3) hypocarbia and a high FiO2 of 0.6; and 4) normocarbia and a high FiO2. NIRS measurements during each phase were compared with sequential phases using paired t-tests.ResultsThe study cohort included 30 adolescents. Baseline cerebral and tissue oxygenation were 81% ± 9% and 87% ± 5%, respectively. During phase 1, cerebral rSO2 was 83% ± 8%, which decreased to 79% ± 8% in phase 2 (hypocarbia and low FiO2). Cerebral oxygenation partially recovered during phase 3 (81% ± 9%) with the increase in FiO2 and then returned to baseline during phase 4 (83% ± 8%). Each sequential change (e.g., phase 1 to phase 2) in cerebral oxygenation was statistically significant (p < 0.01). Tissue oxygenation remained at 87%–88% throughout the study.ConclusionCerebral oxygenation declined slightly during general anesthesia with the transition from normocarbia to hypocarbic conditions. The rSO2 decrease related to hypocarbia was easily reversed with a return to baseline values by the administration of supplemental oxygen (60% vs. 30%).

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“…We have previously noted the potential impact of the combination of anemia, hypotension, and hypocarbia on rSO 2 , suggesting that close attention to the control of ventilation is important during intraoperative care where inadvertent hyperventilation is commonplace. 7,13 In addition, these data demonstrate that the cerebral rSO 2 decrease related to hypocarbia was reversed by the administration of supplemental oxygen (60% vs. 30%). A secondary mechanism that may provide additional protection to decreases in cerebral rSO 2 in the current study is the effect of anesthetic agents on cerebral oxygen needs.…”

Section: Discussionmentioning

confidence: 69%

1045: Changes in Cerebral Oxygenation Based on Intraoperative Ventilation Strategy

Naples¹,

Hakim²,

Walia³

et al. 2016

Critical Care Medicine

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Introduction: Cerebral oxygenation can be monitored clinically by cerebral oximetry (regional oxygen saturation, rSO 2) using near-infrared spectroscopy (NIRS). Changes in rSO 2 have been shown to precede changes in pulse oximetry, providing an early detection of clinical deterioration. Cerebral oximetry values may be affected by various factors, including changes in ventilation. The aim of this study was to evaluate the changes in rSO 2 during intraoperative changes in mechanical ventilation. Patients and methods: Following the approval of the institutional review board (IRB), tissue and cerebral oxygenation were monitored intraoperatively using NIRS. Prior to anesthetic induction, the NIRS monitor was placed on the forehead and over the deltoid muscle to obtain baseline values. NIRS measurements were recorded each minute over a 5-min period during general anesthesia at four phases of ventilation: 1) normocarbia (35-40 mmHg) with a low fraction of inspired oxygen (FiO 2) of 0.3; 2) hypocarbia (25-30 mmHg) and low FiO 2 of 0.3; 3) hypocarbia and a high FiO 2 of 0.6; and 4) normocarbia and a high FiO 2. NIRS measurements during each phase were compared with sequential phases using paired t-tests. Results: The study cohort included 30 adolescents. Baseline cerebral and tissue oxygenation were 81% ± 9% and 87% ± 5%, respectively. During phase 1, cerebral rSO 2 was 83% ± 8%, which decreased to 79% ± 8% in phase 2 (hypocarbia and low FiO 2). Cerebral oxygenation partially recovered during phase 3 (81% ± 9%) with the increase in FiO 2 and then returned to baseline during phase 4 (83% ± 8%). Each sequential change (e.g., phase 1 to phase 2) in cerebral oxygenation was statistically significant (p < 0.01). Tissue oxygenation remained at 87%-88% throughout the study. Conclusion: Cerebral oxygenation declined slightly during general anesthesia with the transition from normocarbia to hypocarbic conditions. The rSO 2 decrease related to hypocarbia was easily reversed with a return to baseline values by the administration of supplemental oxygen (60% vs. 30%).

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Cerebral oxygenation monitoring using near infrared spectroscopy during controlled hypotension

Abstract: Our preliminary data with a measurement of cerebral oxygenation demonstrates the safety of CH within the accepted mean blood pressure recommendations of 55-65 mmHg.

Cited by 18 publications

References 23 publications

Risks and benefits of deliberate hypotension in anaesthesia: a systematic review

Risks and benefits of deliberate hypotension in anaesthesia: a systematic review

Changes in cerebral oxygenation based on intraoperative ventilation strategy

1045: Changes in Cerebral Oxygenation Based on Intraoperative Ventilation Strategy

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