Multimodal Brain Monitoring Reduces Major Neurologic Complications in Cardiac Surgery

Zanatta, Paolo; Benvenuti, Simone Messerotti; Bosco, Enrico; Baldanzi, Fabrizio; Palomba, Daniela; Valfré, Carlo

doi:10.1053/j.jvca.2011.05.015

Cited by 35 publications

(22 citation statements)

References 39 publications

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“…3 Patients experiencing a total intravenous anesthesia whose body temperature information was recorded in the neurophysiological report were selected. These patients, who experienced stable anesthetic conditions and no neurological complications, belonged to a more extended group of 166 patients who underwent intraoperative neurophysiological monitoring during cardiac surgery with nonpulsatile cardiopulmonary bypass from July 2007 to July 2010.…”

Section: Patientsmentioning

confidence: 99%

“…2,3 This can be done using techniques evaluating brain metabolism (ie, near-infrared spectroscopy and oxygen venous saturation from a jugular bulb), hemodynamics (ie, transcranial Doppler), and functioning (ie, electroencephalography [EEG] and somatosensory-evoked potentials [SSEPs]). 3 In the last few years, several studies have investigated the effects of hypothermia on the EEG and SSEP signals, both in animal models and humans. 4,5 Although multimodal brain monitoring during cardiac operations is not yet routine, EEG and SSEP monitoring is frequently performed in clinical practice and its utility has been advocated during cardiac surgery with hypothermic cardiopulmonary bypass (CPB).…”

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confidence: 99%

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Effect of Mild Hypothermic Cardiopulmonary Bypass on the Amplitude of Somatosensory-evoked Potentials

Zanatta¹,

Bosco²,

Comin

et al. 2014

Journal of Neurosurgical Anesthesiology

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Section: Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Mild Hypothermic Cardiopulmonary Bypass on the Amplitude of Somatosensory-evoked Potentials

Zanatta¹,

Bosco²,

Comin

et al. 2014

Journal of Neurosurgical Anesthesiology

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“…A multimodal monitoring approach has also been suggested by Zanatta et al with TCD, NIRS and somatosensory evoked potentials (SEPs). (14) SEP measurements are well validated, but the method requires training, may be time consuming and may be considered impractical for Stanford type A dissections.…”

Section: Discussionmentioning

confidence: 99%

Neuromonitoring with Intermittent Transcranial Doppler Sonography and Continuous Near Infrared Spectroscopy in Aortic Arch Surgery: An Observational Study

Thudium¹,

Kornilov²,

Hilbert³

et al. 2020

Preprint

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Background Aortic Arch repair for aortic dissection is still associated with a high mortality rate. Adequate means of neuromonitoring to guide cerebral hemodynamics, especially during selective anterior cerebral perfusion (SACP) are desirable. It is possible that this cannot be achieved by one monitoring modality alone. It was the objective of this study to investigate an easy multimodal monitoring setup consisting of EEG, near infrared spectroscopy (NIRS) and transcranial doppler sonography. Methods Patients with surgery for aortic dissection were included. In addition to standard hemodynamic monitoring, patients received continuous bilateral NIRS, processed EEG with bispectral index (BIS) and intermittent transcranial doppler sonography of the medial cerebral artery (MCA) with a standard B-mode ultrasound device. Doppler measurements were taken bilaterally before cardiopulmonary bypass (CPB), during CPB and during the selective brain perfusion phase in regular intervals Results Six patients with aortic dissection could be included. Two patients died, one in the operating room and one on ICU. Four patients survived without neurological deficit. Two, however, suffered from transient postoperative delirium. Multimodal monitoring led to change in CPB flow or cannula repositioning in 3 patients (50%). Left sided mean flow velocities of the MCA significantly decreased during selective brain perfusion (p = 0.028), as did BIS values (p = 0.028) Conclusions Multimodal monitoring consisting of BIS, NIRS and B-Mode transcranial sonography can have an impact on hemodynamic management in aortic arch operations. More research is needed to establish target parameters of cerebral perfusion.

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“…Open heart surgery 2 Cardiopulmonary bypass machine 3 Extra corporal circulation 4 Closed heart surgery 5 Patent ductus arteriosus 6 Femoral vein 7 Femoral artery 8 Congenital heart disease 9 Anomalous coronary arteries 10 Anomalous left coronary artery from the pulmonary artery 11 Anomalous aortic origin of coronary artery 12 Aortic stenosis 13 Aorto pulmonary window 14 Atrial septal defect…”

Section: ‫مقاله:‬ ‫اطالعات‬mentioning

confidence: 99%

Incidence of Acute Neurologic Complications after Heart Surgery in Children with Congenital Heart Disease

استقامت¹,

استقامت²,

اشرفی³

et al. 2015

Shefaye Khatam

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According to the nature of heart diseases and the use of cardiopulmonary bypass, transient or permanent neurologic complications may arise during or after pediatric cardiac surgery. The aim of this study was to evaluate the incidence of acute neurologic complications in postoperative cardiac surgery period in children with congenital heart diseases (CHD) undergoing cardiac surgery. Materials and Methods: In this study, all patients with cardiovascular disease (including CHD and other cardiovascular diseases) had been operated (open or closed) in the Children's Medical Center, Tehran, Iran, were evaluated for a year between July 2014 and July 2015. Those who had died during hospital stay or surgery, patients with incomplete information in their medical records, and children who had not been operated because of CHD were excluded. Of the 435 patients surveyed, 364 patients were enrolled in this study. Acute neurologic complications and related findings in brain CT scan were investigated. Results: The age range for patients was between 5 days to 15 years old, of whom 64 (17.6%) patients were under 2 months, 131 (36%) patients were between 2 months to 1 year, and 169 (46.6%) patients were over one year. Thirty-three patients (9.06%) were identified with acute neurological complications after heart surgery, including seizures, movement disorders, loss of consciousness, visual disturbances, headache, and hydrocephalus. Conclusion: Improving the implementation of the cardiopulmonary bypass protocols and using neural monitoring for ischemia and bleeding as well as arterial filter during surgery can reduce the incidence of neurological complications after pediatric cardiac surgery.

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Multimodal Brain Monitoring Reduces Major Neurologic Complications in Cardiac Surgery

Cited by 35 publications

References 39 publications

Effect of Mild Hypothermic Cardiopulmonary Bypass on the Amplitude of Somatosensory-evoked Potentials

Effect of Mild Hypothermic Cardiopulmonary Bypass on the Amplitude of Somatosensory-evoked Potentials

Neuromonitoring with Intermittent Transcranial Doppler Sonography and Continuous Near Infrared Spectroscopy in Aortic Arch Surgery: An Observational Study

Incidence of Acute Neurologic Complications after Heart Surgery in Children with Congenital Heart Disease

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