External carotid artery flow maintains near infrared spectroscopy-determined frontal lobe oxygenation during ephedrine administration

Sørensen, Henrik; Rasmussen, Peter; Sato, Kohei; Persson, S. G. B.; Olesen, Niels D.; Nielsen, Henning Bay; Olsen, N V; Ogoh, Shigehiko; Secher, Niels H.

doi:10.1093/bja/aet481

Cited by 37 publications

(47 citation statements)

References 45 publications

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“…However, there is a concern regarding contamination from superficial tissues. [25][26][27] Both the authors' overall findings and the example in Fig 2 thus may be subject to contamination from superficial tissues. Regarding the overall results, it would be expected that, given the near-fixed "cardiac" output during CPB, a change in skin circulation with an increased NE dose would lead to decreased oxygen saturation in superficial tissues.…”

Section: Discussionmentioning

confidence: 88%

Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

Hagen

Høiseth

Roslin

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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Section: Discussionmentioning

confidence: 88%

Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

Hagen

Høiseth

Roslin

et al. 2016

Journal of Cardiothoracic and Vascular Anesthesia

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“…The use of vasopressors was balanced during reperfusion of the aorta. Phenylephrine reduces S c O 2 by vasoconstriction within extra-cerebral tissue [4,30] that may have caused false positive events of cerebral deoxygenation, but none of the three patient with cerebral deoxygenation received phenylephrine. As phenylephrine is administered frequently during reperfusion, we cannot exclude that S c O 2 , as an expression of CBF, may be an underestimate due to skin vasoconstriction.…”

Section: Discussionmentioning

confidence: 99%

Near-infrared spectroscopy assessed cerebral oxygenation during open abdominal aortic aneurysm repair: relation to end-tidal CO2 tension

Sørensen

Nielsen

Secher

2015

J Clin Monit Comput

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During open abdominal aortic aneurism (AAA) repair cerebral blood flow is challenged. Clamping of the aorta may lead to unintended hyperventilation as metabolism is reduced by perfusion of a smaller part of the body and reperfusion of the aorta releases vasodilatory substances including CO2. We intend to adjust ventilation according end-tidal CO2 tension (EtCO2) and here evaluated to what extent that strategy maintains frontal lobe oxygenation (ScO2) as determined by near infrared spectroscopy. For 44 patients [5 women, aged 70 (48-83) years] ScO2, mean arterial pressure (MAP), EtCO2, and ventilation were obtained retrospectively from the anesthetic charts. By clamping the aorta, ScO2 and EtCO2 were kept stable by reducing ventilation (median, -0.8 l min(-1); interquartile range, -1.1 to -0.4; P < 0.001). During reperfusion of the aorta a reduction in MAP by 8 mmHg (-15 to -1; P < 0.001) did not prevent an increase in ScO2 by 2 % (-1 to 4; P < 0.001) as EtCO2 increased 0.5 kPa (0.1-1.0; P < 0.001) despite an increase in ventilation by 1.8 l min(-1) (0.9-2.7; P < 0.001). Changes in ScO2 related to those in EtCO2 (r = 0.41; P = 0.0001) and cerebral deoxygenation (-15 %) was noted in three patients while cerebral hyperoxygenation (+15 %) manifests in one patient. Thus changes in ScO2 were kept within acceptable limits (±15 %) in 91 % of the patients. For the majority of the patients undergoing AAA repair ScO2 was kept within reasonable limits by reducing ventilation by approximately 1 l min(-1) upon clamping of the aorta and increasing ventilation by approximately 2 l min(-1) when the lower body is reperfused.

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“…Secondly, the ratio between influence from skin and cerebral oxygenation to the NIRS signal remains debated. Over a broad range of interventions known to affect SkBF and/or cerebral oxygenation a 35 % contribution has been suggested [25]. However, the ratio may likely vary between interventions, thus, taking the present findings into account it seems that when SkBF is altered it is reflected in the NIRS-derived value for cerebral oxygenation.…”

Section: Limitationsmentioning

confidence: 61%

“…Moreover, NIRS apparatus uses this subtraction method with difference source-detector distance from 15 to 30 mm [25]. Nevertheless, the NIRS signal with a subtraction algorithm is unable to isolate cerebral oxygenation from extra cranial tissues.…”

Section: Discussionmentioning

confidence: 99%

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Near-infrared spectroscopy determined cerebral oxygenation with eliminated skin blood flow in young males

Hirasawa

Kaneko

Tanaka

et al. 2015

J Clin Monit Comput

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We estimated cerebral oxygenation during handgrip exercise and a cognitive task using an algorithm that eliminates the influence of skin blood flow (SkBF) on the near-infrared spectroscopy (NIRS) signal. The algorithm involves a subtraction method to develop a correction factor for each subject. For twelve male volunteers (age 21 ± 1 yrs) +80 mmHg pressure was applied over the left temporal artery for 30 s by a custom-made headband cuff to calculate an individual correction factor. From the NIRS-determined ipsilateral cerebral oxyhemoglobin concentration (O2Hb) at two source-detector distances (15 and 30 mm) with the algorithm using the individual correction factor, we expressed cerebral oxygenation without influence from scalp and scull blood flow. Validity of the estimated cerebral oxygenation was verified during cerebral neural activation (handgrip exercise and cognitive task). With the use of both source-detector distances, handgrip exercise and a cognitive task increased O2Hb (P < 0.01) but O2Hb was reduced when SkBF became eliminated by pressure on the temporal artery for 5 s. However, when the estimation of cerebral oxygenation was based on the algorithm developed when pressure was applied to the temporal artery, estimated O2Hb was not affected by elimination of SkBF during handgrip exercise (P = 0.666) or the cognitive task (P = 0.105). These findings suggest that the algorithm with the individual correction factor allows for evaluation of changes in an accurate cerebral oxygenation without influence of extracranial blood flow by NIRS applied to the forehead.

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External carotid artery flow maintains near infrared spectroscopy-determined frontal lobe oxygenation during ephedrine administration

Cited by 37 publications

References 45 publications

Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

Impact of Norepinephrine on Regional Cerebral Oxygenation During Cardiopulmonary Bypass

Near-infrared spectroscopy assessed cerebral oxygenation during open abdominal aortic aneurysm repair: relation to end-tidal CO2 tension

Near-infrared spectroscopy determined cerebral oxygenation with eliminated skin blood flow in young males

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