Intraoperative cerebral high-intensity transient signals and postoperative cognitive function: a systematic review

Martin, Kristin K.; Wigginton, Jeremy B.; Babikian, Viken L.; Pochay, Val E.; Crittenden, Michael D.; Rudolph, James L.

doi:10.1016/j.amjsurg.2007.12.060

Cited by 93 publications

(82 citation statements)

References 65 publications

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“…6 The early concern regarding microembolism to the brain during cardiac surgery being a cause of postoperative cognitive dysfunction 26,27 has not been confirmed in more recent studies 28 and systematic reviews. 29,30 Liu et al 31 reported a median embolic count of 430 (range, 155-2088) in patients undergoing cardiac surgery with cardiopulmonary bypass against a median embolic count of 2 (range, 0 -66) in off-pump surgery but could show no difference in cognitive outcome. While the number of microemboli seen during cardiac surgery is much greater than that during orthopedic surgery, these are more likely to be predominantly gaseous.…”

Section: Discussionmentioning

confidence: 99%

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Silbert

Evered

Scott

et al. 2013

AJNR Am J Neuroradiol

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SUMMARY:Transcranial Doppler ultrasonography has been used to detect microemboli in the middle cerebral artery during orthopedic surgery. We conducted a comprehensive systematic literature review of transcranial Doppler ultrasonography in orthopedic surgery to evaluate its status in this setting. Fourteen studies were selected for qualitative analysis. The highest number of patients studied was 45; emboli were detected in all studies, occurring in 20%-100% of patients. Most embolic counts were below 10, but some high counts were noted. No study reported all the technical parameters of the transcranial Doppler ultrasonography. All studies assessed neurologic status, and 6 studies evaluated cognitive function postoperatively. No study identified an association between postoperative cognitive function and embolic count. Six studies sought the presence of right-to-left shunts. ABBREVIATIONS:HITS ϭ high-intensity transient signals; PFO ϭ patent foramen ovale; TCD ϭ transcranial Doppler ultrasonography; TEE ϭ transesophageal

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Section: Discussionmentioning

confidence: 99%

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Silbert

Evered

Scott

et al. 2013

AJNR Am J Neuroradiol

View full text Add to dashboard Cite

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“…19 During full-body CPB, these particles would otherwise travel to the abdominal circulation. 20 The high incidence of new WMI in our study deserves further attention (67% of the whole cohort) because this affected three quarters of all patients. Previous studies of primarily univentricular patients in whom preoperative and postoperative MRI studies were performed reported new WMI in 16% to 47% of patients.…”

Section: Discussionmentioning

confidence: 99%

Neurological Injury After Neonatal Cardiac Surgery

et al. 2014

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S urvival after neonatal cardiac surgery has improved over the past decades to >90% because of major advances in surgical techniques and perioperative management. However, it has also become evident that neurodevelopment is impaired in approximately one third of children who underwent surgery at a neonatal age.1 As seen on magnetic resonance imaging (MRI), 23% to 40% of neonates presenting with a complex cardiac defect already have evidence of cerebral injury preoperatively.2-6 After surgery, 36% to 73% of patients have evidence of new cerebral lesions on MRI. [2][3][4][5][6][7][8] This suggests that much of the injury develops perioperatively. Clinical Perspective on p 233Neonates diagnosed with aortic arch obstruction (ie, hypoplastic left heart syndrome or other complex cardiac defects) are consistently at the highest risk of cerebral injury. 5,7,9 This may be attributable to the fact that full-flow cardiopulmonary bypass (CPB) is not feasible during the reconstruction of the aortic arch, obligating the use of either deep hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion (ACP). Despite initial reports on the adverse cerebral effects after DHCA and the intuitive benefit of ACP, previous studies have not been able to show superiority of ACP in studies of neurodevelopmental outcome at 1 year of age. 10,11 However, these results may be confounded by the reoperations that frequently take place in the interim.Therefore, in the present randomized, controlled trial, we used preoperative and postoperative MRI as the most sensitive measure to assess perioperative cerebral injury. Specifically, in neonates undergoing aortic arch reconstruction, the incidence of new postoperative injury on MRI was compared between DHCA and ACP.Background-Complex neonatal cardiac surgery is associated with cerebral injury. In particular, aortic arch repair, requiring either deep hypothermic circulatory arrest (DHCA) or antegrade cerebral perfusion (ACP), entails a high risk of perioperative injury. It is unknown whether ACP results in less cerebral injury than DHCA. Methods and Results-Thirty-seven neonates with an aortic arch obstruction presenting for univentricular or biventricular repair were randomized to either DHCA or ACP. Preoperatively and 1 week after surgery, magnetic resonance imaging was performed in 36 patients (1 patient died during the hospital stay). The presence of new postoperative cerebral injury was scored, and results were entered into a sequential analysis, which allows for immediate data analysis. After the 36th patient, it was clear that there was no difference between DHCA and ACP in terms of new cerebral injury. Preoperatively, 50% of patients had evidence of cerebral injury.

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“…In the perioperative setting, TCD has a range of applications in anaesthesia [62, 65] and in surgical monitoring, notably in the detection and classification of emboli during endartectomy and cardiac surgery [74,84,86].…”

Section: Clinical Applications Of Tcdmentioning

confidence: 99%

Transcranial Doppler for evaluation of cerebral autoregulation

2009

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Transcranial Doppler ultrasound (TCD) can measure cerebral blood flow velocity in the main intracranial vessels non-invasively and with high accuracy. Combined with the availability of non-invasive devices for continuous measurement of arterial blood pressure, the relatively low cost, ease-of-use, and excellent temporal resolution of TCD have stimulated the development of new techniques to assess cerebral autoregulation in the laboratory or bedside using a dynamic approach, instead of the more classical 'static' method. Clinical applications have shown consistent results in certain conditions such as severe head injury and carotid artery disease. Studies in syncopal patients revealed a more complex pattern due to aetiological non-homogeneity and methodological limitations mainly due to inadequate sample-size. Different analytical models to quantify autoregulatory performance have also contributed to the diversity of results in the literature. The review concludes with specific recommendations for areas where further validation and research are needed to improve the reliability and usefulness of TCD in clinical practice.

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Intraoperative cerebral high-intensity transient signals and postoperative cognitive function: a systematic review

Cited by 93 publications

References 65 publications

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Review of Transcranial Doppler Ultrasound to Detect Microemboli during Orthopedic Surgery

Neurological Injury After Neonatal Cardiac Surgery

Transcranial Doppler for evaluation of cerebral autoregulation

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