Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery

Abstract

Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation (rScO2) during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed (i) to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and (ii) to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparoscopic surgery with the patient placed in anti-Tredelenburg's position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery (ICA) also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic, and abdominal surgery the occurrence of postoperative cognitive dysfunction (POCD) might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of rScO2. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.

Challenges in anaesthesia for elderly

“…The evidence on effectiveness of minimizing cerebral oxygen desaturation and depth of sleep has been divergent [32,55,[59][60][61][62][63][64][65][66], but there is mounting evidence from several randomised, controlled trials that anaesthetic administration guided by BIS-protocols can decrease POD [62]. However, future research with larger trials is needed to draw conclusions.…”

“…However, the impact of extended monitoring and goal directed therapy on postoperative cognitive changes is not entirely clear. Carefully titrating anaesthesia using perioperative brain monitoring has been a research area of great interest [59]; cerebral oxygen oximetery can be measured by intra-operative nearinfrared spectroscopy (NIRS), and depth of anaesthesia can be guided by continuous recordings of electroencephalograms processed by a bispectral index (BIS) monitor or auditory evoked potentials [32,55,[59][60][61][62][63][64].…”

Examiner’s finger-mounted near-infrared spectroscopy is feasible to analyze cerebral and skeletal muscle oxygenation in conscious Chihuahuas

“…NIRS is thus a clinically useful and advantageous tool for detecting oxygenation levels in local and microcirculatory spaces through the skin and bones and has been used as a noninvasive clinical method in human patients. 3,4 Several investigators have conducted experimental NIRS studies of skin 5 and skeletal muscle 6-9 in dogs. There are a few reports to evaluate cerebral oxygenation level using canine brain NIRS 10 in comparison with human medicine.…”

“…There are a few reports to evaluate cerebral oxygenation level using canine brain NIRS 10 in comparison with human medicine. 1,3 Neuronal cells, astrocytes, pericytes, and capillary endothelial cells in the central nervous system constitute a neurovascular unit. 11 Neuronal activity and metabolism are closely related to regulation of the cerebral microcirculation, indicating that brain autoregulation mechanisms play significant roles in maintaining vital functions of the central nervous system.…”

Cerebral oxygenation in health and disease

“…These authors conclude that O 2 supplementation indeed elevates S c O 2 and skeletal muscle oxygenation in these patients during surgery but does not seem to sufficiently prevent a critical reduction in S c O 2 . Nielsen (2014) reviewed the impact of different surgeries on S c O 2 . His report indicates that the impact of non-cardiac surgery on S c O 2 is highly variable and in some types of surgery, cerebral desaturation may be related to postoperative cognitive dysfunction.…”