Limitations of near infrared spectroscopy (NIRS) in neurosurgical setting: our case experience

Ajayan, Neeraja; Thakkar, Keta; Lionel, Karen Ruby; Hrishi, Ajay Prasad

doi:10.1007/s10877-018-0209-1

Cited by 15 publications

(8 citation statements)

References 8 publications

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“…In addition, it was observed that both right and left NIRSs were always low in Group 1 until 150 min. [24] showed similar results with their study. However, although it was clinically tolerated in patients whose procedures lasted more than two hours, lower oxygenation was observed in the low-flow group.…”

Section: Discussionsupporting

confidence: 87%

The Effect of Low- Flow Anesthesia on Hemodynamic Parameters and Gas Consumption in Single Lung Ventilation

Geyik¹,

Yucel²,

Erkal³

et al. 2021

GKDA Derg

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Objective:We aimed to compare the effects of low and medium high-flow anesthesia on hemodynamic parameters, blood gas values and gas consumption in patients undergoing single lung ventilation. Methods: We studied 40 patients over 18 years of age in ASA I-III group who underwent elective thoracic surgery by single lung ventilation. The patients were intubated with doublelumen tube (DLT) following induction of anesthesia. We randomly divided the patients into two groups. In Group 1, 1L/min (80% oxygen+20% air) 4-6% desflurane; in Group 2, 2L/min (80% oxygen+20% air) was applied. Peripheral oxygen saturation, end-tidal carbon dioxide levels, heart rate, invasive blood pressure values, tidal volume, respiration rate, FiO2, fresh gas flow rate values during single lung ventilation in both groups were recorded. Arterial Blood Gas analysis was performed at 1 hour intervals. The amount of desflurane used at the end of single lung ventilation was monitored by anesthesia device. Results: Desflurane consumption was significantly lower in Group 1 (55.3±18.4 vs. 84.9±37.6,p=0.003). EtCO2 was found to be statistically significantly lower in Group 2, especially between 30 and 75 minutes, and systolic, diastolic, and mean arterial pressure between 45 and 120 minutes. There was no significant difference between the groups in terms of NIRS. Only in both left and right NIRS there was a significant elevation in Group 1 at 120 minutes (p=0.08 and p=0.06, respectively). Conclusion: Low flow with desflurane using appropriate equipment and close monitoring can be safely applied without side effects.

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Section: Discussionsupporting

confidence: 87%

The Effect of Low- Flow Anesthesia on Hemodynamic Parameters and Gas Consumption in Single Lung Ventilation

Geyik¹,

Yucel²,

Erkal³

et al. 2021

GKDA Derg

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“…In this context, rSO 2 could potentially be applied as surrogate of CBF, as NIRS- similarly to TCD- is a low cost, easy available, and safe neuromonitoring tool ( 27 ). For example, NIRS has been previously used for the dynamic assessment of CA, with promising results, but several concerns have been raised regarding its routine use ( 7 , 8 , 29 , 30 ). In particular, as NIR light penetrates skin, subcutaneous fat, skull, and underlying muscles and brain tissue, the absorption of light from chromophores depends on both the changes in oxygenated and deoxygenated haemoglobin, and, therefore, from both the arteriolar and venular beds.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, as NIR light penetrates skin, subcutaneous fat, skull, and underlying muscles and brain tissue, the absorption of light from chromophores depends on both the changes in oxygenated and deoxygenated haemoglobin, and, therefore, from both the arteriolar and venular beds. As a consequence, it has been shown that the absolute number of rSO 2 , as well as its changes, might not be always reliable in practise since venous contamination can lead to misinterpretation of the data ( 29 , 31 ).…”

Section: Discussionmentioning

confidence: 99%

The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients

et al. 2021

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Introduction: The role of near-infrared spectroscopy (NIRS) for the evaluation of cerebral haemodynamics is gaining increasing popularity because of its noninvasive nature. The aim of this study was to evaluate the role of the integral components of regional cerebral oxygenation (rSO2) measured by NIRS [i.e., arterial-oxyhemoglobin (O2Hbi) and venous-deoxyhemoglobin (HHbi)-components], as indirect surrogates of cerebral blood flow (CBF) in a cohort of critically ill patients with coronavirus disease 2019 (COVID-19). We compared these findings to the gold standard technique for noninvasive CBF assessment, Transcranial Doppler (TCD).Methods: Mechanically ventilated patients with COVID-19 admitted to the Intensive Care Unit (ICU) of Policlinico San Martino Hospital, Genova, Italy, who underwent multimodal neuromonitoring (including NIRS and TCD), were included. rSO2 and its components [relative changes in O2Hbi, HHbi, and total haemoglobin (cHbi)] were compared with TCD (cerebral blood flow velocity, CBFV). Changes (Δ) in CBFV and rSO2, ΔO2Hbi, ΔHHbi, and ΔcHbi after systemic arterial blood pressure (MAP) modifications induced by different manoeuvres (e.g., rescue therapies and haemodynamic manipulation) were assessed using mixed-effect linear regression analysis and repeated measures correlation coefficients. All values were normalised as percentage changes from the baseline (Δ%).Results: One hundred and four measurements from 25 patients were included. Significant effects of Δ%MAP on Δ%CBF were observed after rescue manoeuvres for CBFV, ΔcHbi, and ΔO2Hbi. The highest correlation was found between ΔCBFV and ΔΔO2Hbi (R = 0.88, p < 0.0001), and the poorest between ΔCBFV and ΔΔHHbi (R = 0.34, p = 0.002).Conclusions: ΔO2Hbi had the highest accuracy to assess CBF changes, reflecting its role as the main component for vasomotor response after changes in MAP. The use of indexes derived from the different components of rSO2 can be useful for the bedside evaluation of cerebral haemodynamics in mechanically ventilated patients with COVID-19.

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“…In 2010, Robertson et al illustrated that NIRS can only detect intracranial hemorrhages > 3.5 ml at a depth of 2.5 cm [20]. In 2018, Neeraja et al reported that the penetration depth of the sensor is inadequate to compensate for the increased distance between the sensor and brain tissue, thereby resulting in inaccurately high values (>80%) [21]. A shortcoming of EIT is that the highly resistant skull has a natural electrical isolation that limits current penetration and restricts deep imaging of the brain [22].…”

Section: Discussionmentioning

confidence: 99%

A Preliminary Study on the Feasibility of Detecting Global Acute Cerebral Ischemia by the MIPS Method

et al. 2020

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Acute cerebral ischemia is an important clinical disease that is usually detected by magnetic resonance imaging or computed tomography. The magnetic inductive phase shift (MIPS) is a new method for detecting cerebral diseases, which is non-invasive, miniaturized, and low-cost. A total of 25 rabbits were studied using a two-coil sensor with a 0.3-200 MHz frequency range, and all the subjects were measured for 1 hour. Based on the rabbit acute cerebral ischemia model, the rabbits were divided into unilateral ligation, bilateral ligation, and non-ligation groups. The results showed that the average MIPS values of the non-ligation, unilateral ligation, and bilateral ligation group were −0.195 ± 0.079 • , −4.873 ± 1.042 • , and −9.165 ± 2.862 • respectively. MIPS distinguished different severities of cerebral ischemia in rabbits with statistical significance (p < 0.05). Laser Doppler flowmetry (LDF) was used as the gold standard for collecting cerebral blood flow data. The strong correlation between the LDF measurements and the phase shift suggested that the phase shift reflects blood flow changes in the brain. Overall, these results suggest that the MIPS detection method has the potential to provide early detection of global cerebral ischemia. Furthermore, this method effectively distinguished different severities of cerebral ischemia. INDEX TERMS Acute cerebral ischemia, magnetic induction phase shift, laser Doppler flowmetry.

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Limitations of near infrared spectroscopy (NIRS) in neurosurgical setting: our case experience

Cited by 15 publications

References 8 publications

The Effect of Low- Flow Anesthesia on Hemodynamic Parameters and Gas Consumption in Single Lung Ventilation

The Effect of Low- Flow Anesthesia on Hemodynamic Parameters and Gas Consumption in Single Lung Ventilation

The Use of Different Components of Brain Oxygenation for the Assessment of Cerebral Haemodynamics: A Prospective Observational Study on COVID-19 Patients

A Preliminary Study on the Feasibility of Detecting Global Acute Cerebral Ischemia by the MIPS Method

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