Patient management algorithm combining processed electroencephalographic monitoring with cerebral and somatic near-infrared spectroscopy: a case series

Couture, Étienne J.; Deschamps, Alain; Denault, André

doi:10.1007/s12630-019-01305-y

Cited by 14 publications

(6 citation statements)

References 21 publications

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“…More importantly no algorithms were used to simultaneously adapt the information from the cerebral oximetry and from the processed EEG. Integrating information provided by two monitors can indeed be helpful in the perioperative hemodynamic management of patients [40][41][42] . Figure 2 illustrates such an algorithm used in the authors' institution.…”

Section: Discussionmentioning

confidence: 99%

Effect of combined use of cerebral oximetry and electroencephalogram monitoring on the incidence of perioperative neurocognitive disorders in adult cardiac and non-cardiac surgery: A systematic review of randomized and non-randomized trials

Souberbielle¹,

Sariyar²,

Momeni³

2022

Acta Anaest Belg

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Background: There is insufficient evidence to recommend using either intraoperative cerebral oximetry or (processed) electroencephalogram (EEG) alone for preventing perioperative neurocognitive disorders (PNDs). Objective: To evaluate the effectiveness of combined use of cerebral oximetry and electroencephalogram-guided anesthesia on the incidence of PNDs in adult patients undergoing cardiac and non-cardiac interventions. Methods: A PICOS - based systematic review of English articles using Pubmed and Embase (from inception to August 2022) was performed. There were no exclusion criteria regarding the type of the study. Abstract proceedings and new study protocols or ongoing studies were not included. Review articles were analyzed in search of eligible references. All possible terms that were illustrative of PNDs were used. Results: Among the 63 full manuscripts that were analyzed in detail, 15 met the inclusion criteria. We found 2 retrospective, 8 prospective observational and 5 randomized controlled trials of which 1 did not evaluate the use of neuromonitoring in the randomization process. The definition and the methods used to diagnose PNDs were very heterogeneous. Only 8 studies used an algorithm to avoid/treat cerebral oxygen desaturation and/or to treat EEG abnormalities. Overall, there was a tendency towards less PNDs in studies where such an algorithm was used. Conclusions: Our results suggest that integrating information obtained from cerebral oximetry and an EEG monitor may reduce the incidence of PNDs whenever an adapted algorithm is used to improve brain function.

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Section: Discussionmentioning

confidence: 99%

Effect of combined use of cerebral oximetry and electroencephalogram monitoring on the incidence of perioperative neurocognitive disorders in adult cardiac and non-cardiac surgery: A systematic review of randomized and non-randomized trials

Souberbielle¹,

Sariyar²,

Momeni³

2022

Acta Anaest Belg

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“…Cerebral hypoperfusion would be suspected if mean, systolic, and diastolic cerebral blood velocities of the middle cerebral artery are reduced as opposed to venous congestion where only diastolic cerebral blood velocities will be attenuated with the systolic values remaining unchanged. 14 During venous congestion and elevation in central venous pressure, diastolic cerebral blood velocity from TCD will be reduced and the pulsatility index ([systolic velocities -diastolic velocities]/mean velocities) (normal: 0.81-0.97) increased, 10,15 with reductions in both cerebral and somatic NIRS values. Similar signals will be observed 16 although somatic NIRS values would remain normal.…”

Section: Discussionmentioning

confidence: 99%

“…An increase in PI can be associated with elevated intracranial pressure (ICP) or with elevation of the central venous pressure. [14][15][16]25,26 Global somatic desaturation will be present if the reduced TCD diastolic velocity and elevated PI is secondary to venous congestion. Nevertheless, global somatic saturation will be normal or maintained if the mechanism of brain desaturation, reduced TCD diastolic velocity, and elevated PI is secondary to intracranial hypertension.…”

Section: Discussionmentioning

confidence: 99%

A proposed algorithm for combining transcranial Doppler ultrasound monitoring with cerebral and somatic oximetry: a case report

Azzam

Couture

Beaubien‐Souligny

et al. 2020

Can J Anesth/J Can Anesth

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Purpose Transcranial Doppler (TCD) ultrasound is a non-invasive monitor of cerebral blood velocity that can be used intraoperatively. The purpose of this report is to describe how different patterns seen on TCD can help identify the cause of cerebral desaturation when nearinfrared spectroscopy (NIRS) oximetry is used concomitantly. Clinical features A 69-yr-old male patient undergoing coronary revascularisation and aortic valve replacement developed perioperative complications that were detected using a combination of transtemporal TCD of the middle cerebral artery along with cerebral and somatic NIRS.Initial brain desaturation was secondary to hypocapnia during which TCD-derived blood velocity and somatic NIRS values remained unchanged. After the procedure, a second episode of brain desaturation occurred secondary to a technical issue with the aortic valve prosthesis requiring a return to cardiopulmonary bypass (CPB); there were no high-intensity transient signals (HITS) on TCD. Brain desaturation occurred a third time following the second attempt to separate from CPB at which time TCD detected a significant amount of HITS suggesting air emboli that were associated with acute right ventricular dysfunction; there was also a reduction in somatic NIRS.

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“…El pEEG (PSI, BIS, DSA) además de permitir la monitorización de la profundidad anestésica, últimamente ha sido utilizado como una herramienta complementaria al NIRS cerebral y somático para evaluar los cambios en la saturación cerebral. En el algoritmo propuesto por Couture et al, los pacientes sometidos a CC pueden ser clasificados en 4 grandes grupos [40], lo cual facilita la identificación y corrección oportuna de las causas responsables del cambio en la oxigenación cerebral: A) Disminución del NIRS y pEEG: En este escenario se debe sospechar de hipoxia cerebral debido a un flujo sanguíneo cerebral (FSC) insuficiente. Esto, generalmente, refleja una reducción en la presión de perfusión cerebral (PPC), cuyas causas pueden ser sistémicas o regionales.…”

Section: Evaluación De La Actividad Cerebralunclassified

Mantención de la anestesia general y monitorización de la profundidad anestésica en cirugía cardíaca con bypass cardiopulmonar

2022

Rev. chil. anest.

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The cardiovascular anesthesiologist must frequently assume the care of high-risk patients who will undergo complex and invasive surgeries. In order to ensure patient safety and facilitate decision making, great technological advances have been made to monitor them extensively, such as transesophageal echocardiography and sophisticated hemodynamic monitors. Although hypnotics used during general anesthesia act on the brain, the monitoring of this organ was not considered standard behavior for a long time. The classic electroencephalogram (EEG) appeared as a useful tool to evaluate the changes in neuronal electrical activity induced by general anesthesia and thus detect the different states of consciousness during general anesthesia, i.e., to evaluate the depth of anesthesia (DoA). However, its difficult intraoperative interpretation and the scarce evidence available in its favor were the main limitations for the use of this tool as a hypnosis monitor. Processed EEG (pEEG), derived from EEG decomposition, emerges as an easy-to-interpret alternative for anesthesiologists and useful for assessing anesthetic depth. In cardiac surgery, and especially in cardiopulmonary bypass (CPB), achieving safe and stable hypnosis is a great challenge, since there are critical periods that involve a series of changes in the physiology of the patients and in the administration of hypnotics. Given the above, the monitoring of anesthetic depth in this surgical scenario is currently supported by many authors, the main objectives being to reduce the incidence of awareness with intraoperative recall (AWR) due to hypnotic underdosing, to avoid hemodynamic and neurological adverse effects secondary to hypnotic overdosing, and to collaborate in the evaluation of cerebral perfusion during critical periods.

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Patient management algorithm combining processed electroencephalographic monitoring with cerebral and somatic near-infrared spectroscopy: a case series

Cited by 14 publications

References 21 publications

Effect of combined use of cerebral oximetry and electroencephalogram monitoring on the incidence of perioperative neurocognitive disorders in adult cardiac and non-cardiac surgery: A systematic review of randomized and non-randomized trials

Effect of combined use of cerebral oximetry and electroencephalogram monitoring on the incidence of perioperative neurocognitive disorders in adult cardiac and non-cardiac surgery: A systematic review of randomized and non-randomized trials

A proposed algorithm for combining transcranial Doppler ultrasound monitoring with cerebral and somatic oximetry: a case report

Mantención de la anestesia general y monitorización de la profundidad anestésica en cirugía cardíaca con bypass cardiopulmonar

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