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Pollard V, Prough DS, DeMelo AE, Deyo DJ, Uchida T, Widman R. The influence of carbon dioxide and body position on near-infrared spectroscopic assessment of cerebral hemoglobin oxygen saturation. Anesth Analg 1996; 82:278-87. [PMID: 8561327 DOI: 10.1097/00000539-199602000-00011] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Near-infrared spectroscopy may allow continuous and noninvasive monitoring of regional brain hemoglobin oxygen saturation by measuring the differential absorption of infrared light by oxyhemoglobin and deoxyhemoglobin. We have previously examined the correlation between the spectroscopic signal generated by a prototype cerebral oximeter (Invos 3100; Somanetics, Troy, MI), and global brain hemoglobin oxygen saturation calculated from arterial and jugular venous bulb oxygen saturations. Because the technology does not distinguish between arterial and venous hemoglobin saturation, changes in the proportion of cerebral arterial and venous blood volume, which may result from changes in blood flow or venous distending pressure, may confound measurements. In eight conscious volunteers breathing hypoxic oxygen mixtures, we examined the influence of supine, 20 degrees Trendelenburg, and 20 degrees reverse Trendelenburg positions on the correlation of the spectroscopic measurement of cerebral oxygen saturation in the field assessed by the probe (CSfO2) and the calculated brain hemoglobin oxygen saturation (CScombO2), estimated as 0.25 x arterial saturation plus 0.75 x jugular venous bulb oxygen saturation. We found that changes in position did not influence the association between CSfO2 and CScombO2 (r2 = 0.69-0.885) during hypoxic challenge. In a second set of eight volunteers, we studied the influence of hypercapnia and hypocapnia and body position on the association between CSfO2 and CScombO2, and found that they were less well correlated (r2 = 0.366-0.976) in individual patients. Because changes in body position and Paco2 confound the relationship between CSfO2 and CScombO2, changes in CSfO2 can best be assessed if position and Paco2 are constant.
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Affiliation(s)
- V Pollard
- Department of Anesthesiology, University of Texas Medical Branch, Galveston 77555-0591, USA
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52
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Pollard V, Prough DS, DeMelo AE, Deyo DJ, Uchida T, Stoddart HF. Validation in Volunteers of a Near-Infrared Spectroscope for Monitoring Brain Oxygenation In Vivo. Anesth Analg 1996. [DOI: 10.1213/00000539-199602000-00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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53
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Pollard V, Prough DS, DeMelo AE, Deyo DJ, Uchida T, Widman R. The Influence of Carbon Dioxide and Body Position on Near-Infrared Spectroscopic Assessment of Cerebral Hemoglobin Oxygen Saturation. Anesth Analg 1996. [DOI: 10.1213/00000539-199602000-00011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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54
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Harris DN, Bailey SM, Cowans F, Wertheim D. Effect of optode separation on brain penetration in adults. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1996; 388:133-5. [PMID: 8798803 DOI: 10.1007/978-1-4613-0333-6_15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- D N Harris
- Department of Anaesthesia, Royal Postgraduate Medical School, London, United Kingdom
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55
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Kaminogo M, Ichikura A, Shibata S, Toba T, Yonekura M. Effect of acetazolamide on regional cerebral oxygen saturation and regional cerebral blood flow. Stroke 1995; 26:2358-60. [PMID: 7491664 DOI: 10.1161/01.str.26.12.2358] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE To verify whether the monitoring of regional cerebral oxygen saturation (rSO2) with transcranial near-infrared spectroscopy would successfully reflect changes in intracranial hemodynamics but not changes in extracranial compartment, we measured rSO2 and regional cerebral blood flow (rCBF) simultaneously in seven patients with cerebral ischemia and five normal volunteers before and after acetazolamide administration. SUMMARY OF REPORT The baseline values of rSO2 and rCBF were 64.2 +/- 5.6% and 53.9 +/- 11.1 mL/100 g per minute, respectively. rCBF increased by 44.4 +/- 23.3% and rSO2 significantly increased to 69.6 +/- 5.6% after acetazolamide administration. Bilateral simultaneous measurement of rSO2 indicated a tendency that the larger the delta rSO2, the greater the delta%rCBF. The relationship between rSO2 level and rCBF value fit significantly on the theoretical curve calculated from Fick's equation. CONCLUSIONS It is suggested that monitoring of rSO2 with INVOS-3100 could be a useful indicator in the evaluation of intracranial hemodynamic changes.
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Affiliation(s)
- M Kaminogo
- Department of Neurosurgery, Nagasaki University School of Medicine, Japan
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56
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57
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Abstract
Cerebral oximetry was evaluated as a monitor of oxygenation during carotid endarterectomy in 22 patients. The oximeter was a reliable continuous monitor, identifying changes in cerebral oxygenation during episodes of hypotension and after arterial occlusion. Changes in oxygenation correlated well with the surgical assessment of backbleeding after arterial clamping, but less well with other methods which are used to make a decision on insertion of an arterial shunt. There was no correlation between internal carotid artery stump pressure and change in cerebral oxygenation after application of the arterial cross clamp. However, cerebral oxygenation correlated weakly with the change in middle cerebral artery velocity as measured by transcranial Doppler ultrasonography (r = 0.49, p < 0.02).
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Affiliation(s)
- L A Duncan
- Department of Anaesthesia, Royal Infirmary, Edinburgh
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58
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Smielewski P, Kirkpatrick P, Minhas P, Pickard JD, Czosnyka M. Can cerebrovascular reactivity be measured with near-infrared spectroscopy? Stroke 1995; 26:2285-92. [PMID: 7491652 DOI: 10.1161/01.str.26.12.2285] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE We used near-infrared spectroscopy (NIRS) to monitor the cerebral oxygenation changes during CO2 reactivity tests. METHODS Fifty healthy volunteers were examined (age range, 19 to 68 years). The monitored parameters were as follows: transcranial Doppler (TCD) time-averaged middle cerebral artery flow velocity end-tidal CO2 (EtCO2); change in concentration of cerebral oxyhemoglobin (HbO2), deoxyhemoglobin (Hb), and total hemoglobin; mean arterial blood pressure; peripheral arterial oxygen saturation (SaO2); and extracranial tissue perfusion with the use of cutaneous laser-Doppler flowmetry. The examination protocol included both hypercapnia and hypocapnia. The cerebrovascular reactivity indexes were calculated as follows: TCD, relative change in flow velocity per 1 kPa increase in EtCO2; NIRS, absolute change in HbO2, Hb, and total hemoglobin concentration (micromoles per liter) per 1 kPa increase in EtCO2. RESULTS Mean middle cerebral artery flow velocity was found to be 58 cm/s at a mean baseline EtCO2 of 4.7 kPa. Mean cerebrovascular reactivities were as follows: TCD, 24%/kPa (SEM, 1.1); HbO2, 2.06 mumol/L per kilopascal (SEM, 0.08); Hb, -0.63 mumol/L per kilopascal (SEM, 0.09); and total hemoglobin concentration, 1.44 mumol/L per kilopascal (SEM, 0.1). Statistical analysis revealed significant correlation between reactivities calculated with the use of NIRS and TCD (P < .001). Although some fluctuations were observed in SaO2 and laser-Doppler flux, they were not correlated with either EtCO2 or NIRS. CONCLUSIONS NIRS signal changes in HbO2, Hb, and total hemoglobin concentration are very sensitive to alterations in EtCO2, which are largely independent of extracranial tissue perfusion. NIRS may be developed as an alternative method for testing cerebrovascular reactivity and may be of particular clinical importance when the ultrasound window is poor.
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Affiliation(s)
- P Smielewski
- Medical Research Council Cambridge Centre for Brain Repair and Academic Neurosurgical Unit, Addenbrooke's Hospital, University of Cambridge, UK
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59
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Colier WN, van Haaren NJ, Oeseburg B. A comparative study of two near infrared spectrophotometers for the assessment of cerebral haemodynamics. ACTA ANAESTHESIOLOGICA SCANDINAVICA. SUPPLEMENTUM 1995; 107:101-5. [PMID: 8599259 DOI: 10.1111/j.1399-6576.1995.tb04342.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Conventional near infrared spectroscopy (NIRS), introduced by Jöbsis in 1977, can be considered as a reliable trend monitor for cerebral oxygenation. Quantisation, however, is complex and cumbersome. Recently a relatively simple system for cerebral oximetry (INVOS 3100, Somanetics Corporation, USA) was developed, measuring the regional oxygen saturation (rSO2) in the capillary bed of the cerebrum, presented as a numerical figure for easy interpretation. In this study a comparison was made between a conventional NIRS instrument and the new INVOS instrument, in order to obtain information about sensitivity and usefulness of the INVOS system. Changes in cerebral haemodynamics were induced by a moderate decrease of the arterial oxygen saturation (SaO2) and by varying the arterial carbon dioxide level (PaCO2). This will result in a higher (hypercapnia) or lower (hypocapnia) cerebral blood flow and subsequent change of both NIRS signals and INVOS signal. Healthy volunteers were used for this study. It was found that the steady state value for rSO2 was 70 +/- 6% (mean +/- SD). During the lowering of arterial saturation a poor correlation was found between rSO2 and SaO2 (r = 0.47). Increased cerebral blood flow induced by hypercapnia was detected by both conventional NIRS and the INVOS. Decreased cerebral blood flow induced by hypocapnia could only be detected by conventional NIRS. It was concluded that due to the variation in displayed rSO2 and the high amount of averaging in the algorithm the INVOS instrument does not yet provide more information than conventional NIRS.
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Affiliation(s)
- W N Colier
- Department of Physiology, Faculty of Medical Sciences, University of Nijmegen, The Netherlands
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60
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Mirow N, Minami K, Reiβ N, Miche E, Honikel O, Körfer R. Successful Detection of Cerebral Hypoperfusion by near Infrared Spectroscopy in Two Patients with Dissecting Aortic Aneurysm. Asian Cardiovasc Thorac Ann 1995. [DOI: 10.1177/021849239500300411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Near infrared spectroscopy is being used to monitor mixed cerebral oxygen saturation intraoperatively. In 2 patients receiving surgical treatment for acute aortic dissection, cerebral hypoperfusion was detected by near infrared spectroscopy (INVOS3100, Somanetics Corporation, Troy, MI, USA) and corrected accordingly. Near infrared spectroscopy may help to prevent serious neuropsychiatric complications in surgery for aortic arch dissection.
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Affiliation(s)
| | | | | | - Eckard Miche
- Department of Cardiology Heart Center North Rhine-Westfalia University of Bochum Bad Oeynhausen, Germany
| | - Olaf Honikel
- Department of Cardiology Heart Center North Rhine-Westfalia University of Bochum Bad Oeynhausen, Germany
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Litscher G, Schwarz G, Jobstmann R, Prietl B, Schleinkofer L. [Near infrared spectroscopy. Limits and problems in the intensive care unit]. BIOMED ENG-BIOMED TE 1995; 40:128-32. [PMID: 7605887 DOI: 10.1515/bmte.1995.40.5.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Near infrared spectroscopy is a non-invasive method of calculating changes in cerebral oxygenation. We have now evaluated a new near infrared spectroscope, the NIRO-500 (Hamamatsu Photonics, Japan), in an intensive care unit setting. The influence of extracerebral and intracerebral physical-technical, physiological and pathophysiological parameters was investigated. The results showed that the method is very sensitive to changes in oxygenation and perfusion in the cerebral vasculature. However, the influence of other factors can be considerable and not always easy to detect and interpret.
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Affiliation(s)
- G Litscher
- AG für Biomedizinsche Technik, Univ.-Klinik für Anästhesiologie Graz
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Germon TJ, Young AE, Manara AR, Nelson RJ. Extracerebral absorption of near infrared light influences the detection of increased cerebral oxygenation monitored by near infrared spectroscopy. J Neurol Neurosurg Psychiatry 1995; 58:477-9. [PMID: 7738560 PMCID: PMC1073439 DOI: 10.1136/jnnp.58.4.477] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The detection of increased cerebral oxygenation secondary to cerebral hyperaemia, induced by hypercapnia has been studied in anaesthetised patients using a near infrared, reflectance mode, cerebral oxygenation monitor (Invos 3100 Somanetics, Troy, Michigan, USA). Two studies were performed, with and without a pneumatic scalp tourniquet, to distinguish between extracranial and intracranial changes in tissue oxygenation. In the control study a mean increase in end tidal CO2 of 23.1 mm Hg was accompanied by a mean increase in middle cerebral artery flow velocity of 116%. Regional cerebral oxygen saturation (rSO2) measured transcutaneously in the frontal distribution of the middle cerebral artery increased significantly from 70.5% to 74.6% (p = 0.001). During the second study with a scalp tourniquet inflated to maintain the extracranial tissues in a state of stable ischaemia a mean increase in end tidal CO2 of 22.3 mm Hg was accompanied by a mean increase in middle cerebral artery flow velocity of 121%. The change in rSO2 from 62.6% to 64.5% was not significant (p = 0.085). There was no correlation between the change in middle cerebral artery flow velocity and rSO2 in the control or scalp ischaemia group. This study shows that the Invos 3100 monitor is sensitive to tissue oxygenation but does not reliably detect changes in cerebral oxygenation as a result of profound cerebral hyperaemia. The contribution of extracerebral tissue to the attenuation of near infrared light and the lack of spatial resolution remain major problems to be overcome before this or other near infrared spectroscopy instruments can be introduced into clinical practice.
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Affiliation(s)
- T J Germon
- Department of Neurosurgery, Frenchay Hospital, Bristol, UK
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63
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LITSCHER G, SCHWARZ G, KLEINERT R. Die Nahinfrarot-Spektroskopie - Eine Methode zur nicht-invasiven Überwachung der zerebralen Oxygenierung des Gehirns? Kritische Betrachtungen, Möglichkeiten und Grenzen bei Erwachsenen. BIOMED ENG-BIOMED TE 1995. [DOI: 10.1515/bmte.1995.40.s2.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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64
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Slavin KV, Dujovny M, Ausman JI, Hernandez G, Luer M, Stoddart H. Clinical experience with transcranial cerebral oximetry. SURGICAL NEUROLOGY 1994; 42:531-9; discussion 540. [PMID: 7825108 DOI: 10.1016/0090-3019(94)90084-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Transcranial cerebral oximetry based on the principle of near-infrared spectroscopy has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. The non-invasive technique of cerebral oximetry provides valuable information about brain oxygenation in patients with cerebral ischemia (due to occlusion or stenosis of the internal carotid artery). It is also used in intraoperative monitoring of carotid endarterectomy and surgical procedures performed under deep hypothermia and circulatory arrest, during neuroendovascular procedures, and in critical care settings (in patients with arterial vasospasm and during the terminal period). This article describes our preliminary clinical experience with the use of this new technique and summarizes the current literature on clinical and experimental use of transcranial cerebral oximetry.
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Affiliation(s)
- K V Slavin
- Department of Neurosurgery, University of Illinois at Chicago 60612
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65
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Williams IM, Picton AJ, Hardy SC, Mortimer AJ, McCollum CN. Cerebral hypoxia detected by near infrared spectroscopy. Anaesthesia 1994; 49:762-6. [PMID: 7978129 DOI: 10.1111/j.1365-2044.1994.tb04446.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Near infrared spectroscopy is a relatively new technique for monitoring intracerebral oxygen saturation. Using the technique, three episodes of cerebral hypoxia were detected during elective carotid endarterectomy which were not reliably recorded by more standard monitoring of cerebral perfusion. In one case, cerebral hypoxia was related to slippage of the tracheal tube into the right main bronchus and in the other two to episodes of hypotension. Near infrared spectroscopy is a reliable indicator of peripheral cortical perfusion and provides continuous and noninvasive monitoring of intracerebral oxygen saturation.
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Affiliation(s)
- I M Williams
- Department of Surgery, University Hospital of South Manchester, West Didsbury
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66
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Germon TJ, Manara AR, Kane NM, Nielson RJ. Possible limitations of cerebral oximetric monitoring in adults. Anaesthesia 1994; 49:639-40. [PMID: 8042737 DOI: 10.1111/j.1365-2044.1994.tb14240.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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