Increased Oxygen Administration Improves Cerebral Oxygenation in Patients Undergoing Awake Carotid Surgery

Stoneham, Mark D.; Lodi, Omer; Beer, Thearina C D de; Sear, J.W.

doi:10.1213/ane.0b013e318184d6c3

Cited by 34 publications

(27 citation statements)

References 26 publications

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“…5,6 Increasing F io 2 during carotid endarterectomy with regional anesthesia has also been reported to reverse neurological deficits seen with carotid cross clamp placement. 25 Our results are consistent with these data as well as with findings from the static comparison of two P etco 2 ranges in the beach chair position; 13 rSO 2 was better preserved with fewer cerebral desaturation events at the higher P etco 2 range.…”

Section: Discussionmentioning

confidence: 98%

“…The first measurement in the beach chair position (set point two) was obtained either, 1) 15 minutes after positioning, allowing the maximal decrease in rSO 2 to occur, 8 or 2) immediately if cerebral desaturation (defined as absolute value rSO 2 < 55% or a decrease from baseline of ≥ 20%) was sustained for ≥ 3 minutes in either hemisphere. Since the change in rSO 2 is typically complete and stable within 5 minutes following a change in inspired gas composition, 5 rSO 2 was recorded as a ‘snap shot’ after a minimum of 5 minutes at each subsequent set point. All cerebral desaturation events (absolute value rSO 2 < 55% or a decrease from baseline of ≥ 20% sustained for ≥ 3 minutes) were recorded and communicated by the clinical coordinator to allow intervention as deemed appropriate by the anesthesiologist: exclude and treat hypotension, exclude and treat excessive depth of anesthesia, move to the next ventilation set point if that included increasing F io 2 or P etco 2 .…”

Section: Methodsmentioning

confidence: 99%

“…5,6 Monitoring of rSO 2 in anesthetized patients undergoing surgery in beach chair position has been evaluated 7 and revealed a high incidence of cerebral desaturation (rSO 2 ≥ 20% below baseline). 8 By measuring the relative concentrations of oxyhemoglobin and deoxyhemoglobin, cerebral near infra-red spectroscopy (NIRS) provides an estimate of the balance between cerebral oxygen supply and demand within the field of view.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Ventilation Strategies and Anesthetic Techniques on Regional Cerebral Oximetry in the Beach Chair Position

et al. 2015

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Background Beach chair positioning during general anesthesia is associated with cerebral oxygen desaturation. Changes in cerebral oxygenation resulting from the interaction of inspired oxygen fraction, end-tidal carbon dioxide and anesthetic choice have not been fully evaluated in anesthetized patients in the beach chair position. Methods This was a prospective interventional within-group study of patients undergoing shoulder surgery in the beach chair position that incorporated a randomized comparison between two anesthetics. Fifty-six patients were randomized to receive desflurane or total intravenous anesthesia with propofol. Following induction of anesthesia and positioning, inspired oxygen fraction (Fio2) and minute ventilation were sequentially adjusted for all patients. Regional cerebral oxygenation (rSO2) was the primary outcome and was recorded at each of five set points. Results While maintaining Fio2 at 0.3 and end tidal carbon dioxide (PETCO2) at 30mmHg there was a decrease in rSO2 from 68%, SD 12 to 61%, SD 12 (p<0.001) following beach chair positioning. The combined interventions of increasing Fio2 to 1.0 and increasing Petco2 to 45mmHg resulted in a 14% point improvement in rSO2 to 75%, SD 12 (p <0.001) for patients anesthetized in the beach chair position. There was no significant interaction effect of the anesthetic at the study intervention points. Conclusions Increasing Fio2 and Petco2 resulted in a significant increase in rSO2 that overcomes desaturation in patients anesthetized in the beach chair position and that appears independent of anesthetic choice.

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Section: Discussionmentioning

confidence: 98%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Influence of Ventilation Strategies and Anesthetic Techniques on Regional Cerebral Oximetry in the Beach Chair Position

et al. 2015

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“…22 It has also been shown that breathing 100% oxygen under these circumstances can result in clinical improvements in the neurologic deficit as a result of increased cerebral oxygen saturation in the affected area. 23 …”

Section: Carotid Endarterectomymentioning

confidence: 99%

Perioperative Oxygen Toxicity

Lumb

Walton

2012

Anesthesiology Clinics

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“…27 By 2007, surgical fires occurred frequently enough to become mainstream news and were more common than was generally assumed. 28 Despite half a decade of effort since 2003 to disseminate best practices for preventing surgical fires, peer-reviewed articles such as Stoneham et al 30 still advocated unsafe operating room practices. For example, Zheng and Gravenstein 29 specifically expressed concern that the method of carotid cross-clamping proposed by Stoneham et al, 30 particularly for the up to 1 hour duration they described, might increase the likelihood of an oxygen concentration greater than 30% in the surgical field, 29,30 in direct contradiction to many widely circulated safety protocols.…”

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confidence: 99%

Factors Involved In Dental Surgery Fires: A Review of the Literature

VanCleave

Jones

McGlothlin

et al. 2014

Anesthesia Progress

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Surgical fires are well-characterized, readily preventable, potentially devastating operating room catastrophes that continue to occur from 20 to 100 times per year or, by one estimate, up to 600 times per year in US operating rooms, sometimes with fatal results. The most significant risk factors for surgical fires involve (a) the use of an ignition source, such as laser or electrocautery equipment, in or around an oxygen-enriched environment in the head, neck, and upper torso area and (b) the concurrent delivery of supplemental oxygen, especially via nasal cannula. Nonetheless, while these 2 conditions occur very commonly in dental surgery, especially in pediatric dental surgery where sedation and anesthesia are regularly indicated, there is a general absence of documented dental surgical fires in the literature. Barring the possibility of underreporting for fear of litigation, this may suggest that there is another mechanism or mechanisms present in dental or pediatric dental surgery that mitigates this worst-case risk of surgical fires. Some possible explanations for this include: greater fire safety awareness by dental practitioners, incidental ventilation of oxygen-enriched environments in patient oral cavities due to breathing, or suction used by dental practitioners during procedures. This review of the literature provides a background to suggest that the practice of using intraoral suction in conjunction with the use of supplemental oxygen during dental procedures may alter the conditions needed for the initiation of intraoral fires. To date, there appear to be no published studies describing the ability of intraoral suctioning devices to alter the ambient oxygen concentration in an intraoral environment. In vivo models that would allow examination of intraoral suction on the ambient oxygen concentration in a simulated intraoral environment may then provide a valuable foundation for evaluating the safety of current clinical dental surgical practices, particularly in regard to the treatment of children.

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Increased Oxygen Administration Improves Cerebral Oxygenation in Patients Undergoing Awake Carotid Surgery

Cited by 34 publications

References 26 publications

Influence of Ventilation Strategies and Anesthetic Techniques on Regional Cerebral Oximetry in the Beach Chair Position

Influence of Ventilation Strategies and Anesthetic Techniques on Regional Cerebral Oximetry in the Beach Chair Position

Perioperative Oxygen Toxicity

Factors Involved In Dental Surgery Fires: A Review of the Literature

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