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Inčiūra D, Antuševas A, Aladaitis A, Gimžauskaitė A, Velička L, Kavaliauskienė Ž. Near-infrared spectroscopy as a predictor of cerebral ischaemia during carotid endarterectomy in awake patients. Vascular 2020; 28:301-308. [DOI: 10.1177/1708538119893830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives The aim of our study was to evaluate the near-infrared spectroscopy monitoring system to detect cerebral ischaemia, find indications for selective shunting during carotid endarterectomy and compare it with an internal carotid artery stump pressure monitoring technique in patients operated under local anaesthesia. Methods During January 2015 and November 2018, 131 patients undergoing carotid endarterectomy under local anaesthesia were prospectively included in the study. Near-infrared spectroscopy as intraoperative monitoring was applied and compared with stump pressure. Results Carotid endarterectomy was performed successfully in 106 patients operated under local anaesthesia. Meanwhile, 25 patients developed neurological changes (motor or consciousness impairment, weakness of extremities, cognitive decline) during clamping, and all of them received a shunt. ΔrSO2, stump pressure and rSO2 (–11 ± 8%, 31 ± 6mmHg, 58 ± 11) values were smaller in the group of shunted subjects versus non-shunted group subjects (–2 ± 5%, 61 ± 17 mmHg, 64 ± 8) after 1 min of internal carotid artery clamping ( p < 0.05). Statistical analysis showed a sensitivity of 90% (95% CI: 0.85–0.95) and a specificity of 70% (95% CI: 0.62–0.78) for a ≥10% drop in ΔrSO2 to predict ischaemia symptoms during carotid clamping. Using stump pressure with a cut-off value of ≤40 mmHg for predicting symptoms, the sensitivity was 82% and specificity 54%. Conclusions Near-infrared spectroscopy is a suitable non-invasive cerebral oxygenation monitoring method during carotid endarterectomy. A 10% decrease of ΔrSO2 had a good correlation with clinical cerebral ischaemia signs and matched well with the stump pressure cut-off value of ≤40 mmHg. There is a possibility of near-infrared spectroscopy to replace stump pressure in cerebral oxygenation monitoring during carotid endarterectomy. However, we need larger prospective multicentre studies to identify the optimal threshold for shunt requirement.
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Affiliation(s)
- Donatas Inčiūra
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aleksandras Antuševas
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Adomas Aladaitis
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Gimžauskaitė
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Linas Velička
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Žana Kavaliauskienė
- Clinic of Cardiac, Thoracic and Vascular Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Natarajan P, GuhaBiswas R, Saha A, Narayan P. Persistent cerebral desaturation on near-infrared spectroscopy without neurological insult. Indian J Anaesth 2018; 62:643-645. [PMID: 30166667 PMCID: PMC6100281 DOI: 10.4103/ija.ija_277_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Pooja Natarajan
- Department of Cardiac Anesthesiology, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Rahul GuhaBiswas
- Department of Cardiac Anesthesiology, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Atanu Saha
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Pradeep Narayan
- Department of Cardiac Surgery, NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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Nenna A, Barbato R, Greco SM, Pugliese G, Lusini M, Covino E, Chello M. Near-infrared spectroscopy in adult cardiac surgery: between conflicting results and unexpected uses. J Geriatr Cardiol 2017; 14:659-661. [PMID: 29321795 PMCID: PMC5756738 DOI: 10.11909/j.issn.1671-5411.2017.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/04/2022] Open
Affiliation(s)
- Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Raffaele Barbato
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Giuseppe Pugliese
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Mario Lusini
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Elvio Covino
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Lei L, Katznelson R, Fedorko L, Carroll J, Poonawala H, Machina M, Styra R, Rao V, Djaiani G. Cerebral oximetry and postoperative delirium after cardiac surgery: a randomised, controlled trial. Anaesthesia 2017; 72:1456-1466. [DOI: 10.1111/anae.14056] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- L. Lei
- Departments of Anesthesia and Pain Management; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - R. Katznelson
- Departments of Anesthesia and Pain Management; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - L. Fedorko
- Departments of Anesthesia and Pain Management; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - J. Carroll
- Departments of Anesthesia and Pain Management; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - H. Poonawala
- Departments of Anesthesia and Pain Management; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - M. Machina
- Departments of Anesthesia and Pain Management; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - R. Styra
- Department of Psychiatry; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - V. Rao
- Division of Cardiovascular Surgery; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
| | - G. Djaiani
- Departments of Anesthesia and Pain Management; Toronto General Hospital; University Health Network; University of Toronto; Toronto Ontario Canada
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Green MS, Sehgal S, Tariq R. Near-Infrared Spectroscopy: The New Must Have Tool in the Intensive Care Unit? Semin Cardiothorac Vasc Anesth 2016; 20:213-24. [PMID: 27206637 DOI: 10.1177/1089253216644346] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Standard hemodynamic monitoring such as blood pressure and pulse oximetry may only provide a crude estimation of organ perfusion in the critical care setting. Near-infrared spectroscopy (NIRS) is based on the same principle as a pulse oximeter and allows continuous noninvasive monitoring of hemoglobin oxygenation and deoxygenation and thus tissue saturation "StO2" This review aims to provide an overview of NIRS technology principles and discuss its current clinical use in the critical care setting. The study selection was performed using the PubMed database to find studies that investigated the use of NIRS in both the critical care setting and in the intensive care unit. Currently, NIRS in the critical care setting is predominantly being used for infants and neonates. A number of studies in the past decade have shown promising results for the use of NIRS in surgical/trauma intensive care units during shock management as a prognostic tool and in guiding resuscitation. It is evident that over the past 2 decades, NIRS has gone from being a laboratory fascination to an actively employed clinical tool. Even though the benefit of routine use of this technology to achieve better outcomes is still questionable, the fact that NIRS is a low-cost, noninvasive monitoring modality improves the attractiveness of the technology. However, more research may be warranted before recommending its routine use in the critical care setting.
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Affiliation(s)
- Michael Stuart Green
- Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA
| | - Sankalp Sehgal
- Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA
| | - Rayhan Tariq
- Drexel University College of Medicine/Hahnemann University Hospital, Philadelphia, PA, USA
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Should Cerebral Near-infrared Spectroscopy be Standard of Care in Adult Cardiac Surgery? Heart Lung Circ 2015; 24:544-50. [DOI: 10.1016/j.hlc.2015.01.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/19/2015] [Indexed: 11/18/2022]
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Denault A, Lamarche Y, Rochon A, Cogan J, Liszkowski M, Lebon JS, Ayoub C, Taillefer J, Blain R, Viens C, Couture P, Deschamps A. Innovative approaches in the perioperative care of the cardiac surgical patient in the operating room and intensive care unit. Can J Cardiol 2014; 30:S459-77. [PMID: 25432139 DOI: 10.1016/j.cjca.2014.09.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 02/07/2023] Open
Abstract
Perioperative care for cardiac surgery is undergoing rapid evolution. Many of the changes involve the application of novel technologies to tackle common challenges in optimizing perioperative management. Herein, we illustrate recent advances in perioperative management by focusing on a number of novel components that we judge to be particularly important. These include: the introduction of brain and somatic oximetry; transesophageal echocardiographic hemodynamic monitoring and bedside focused ultrasound; ultrasound-guided vascular access; point-of-care coagulation surveillance; right ventricular pressure monitoring; novel inhaled treatment for right ventricular failure; new approaches for postoperative pain management; novel approaches in specialized care procedures to ensure quality control; and specific approaches to optimize the management for postoperative cardiac arrest. Herein, we discuss the reasons that each of these components are particularly important in improving perioperative care, describe how they can be addressed, and their impact in the care of patients who undergo cardiac surgery.
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Affiliation(s)
- André Denault
- Department of Anesthesiology, Critical Care Program, Montreal Heart Institute, and Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Quebec, Canada.
| | - Yoan Lamarche
- Department of Cardiac Surgery and Critical Care Program, Montreal Heart Institute, and Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Cogan
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mark Liszkowski
- Department of Medicine, Cardiology and Critical Care Program, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Christian Ayoub
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean Taillefer
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Robert Blain
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Claudia Viens
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Couture
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alain Deschamps
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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[Usefulness of Bispectral Index (BIS) monitoring for early detection of cerebral hypoperfusions]. ACTA ACUST UNITED AC 2013; 32:653-8. [PMID: 23953319 DOI: 10.1016/j.annfar.2013.07.802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 07/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The goal of the study was to assess whether clinically significant cerebral hypoperfusion in awake patients would be associated with some alterations in the values of the bispectral index (BIS) monitoring. STUDY DESIGN Observational study. POPULATION AND METHODS We monitored the BIS during endovascular carotid artery occlusion testing in awake patients. RESULTS Twenty-eight patients were included. Twenty-one adequately tolerated the procedure. Their BIS value remained stable throughout the procedure. Four patients had poor angiographic tolerance, but no clinical symptoms. Their BIS value slightly decreased during the test (minimal BIS: 83 [79-87]). Three patients had poor clinical and angiographic tolerance of the occlusion. They all experienced an immediate and dramatic decrease in their BIS value (minimal BIS: ipsilateral to clamping: 50 [45-60]; contralateral to clamping: 48 [45-52]). In all patients, the clinical symptoms and the BIS normalized after deflating the occlusion balloon. CONCLUSION In awake patients, the observed values of the BIS monitoring seem to be associated with clinically relevant cerebral hypoperfusion.
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Vernick WJ, Gutsche JT. Pro: Cerebral Oximetry Should be a Routine Monitor During Cardiac Surgery. J Cardiothorac Vasc Anesth 2013; 27:385-9. [DOI: 10.1053/j.jvca.2012.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Indexed: 12/13/2022]
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Sood ED, Benzaquen JS, Davies RR, Woodford E, Pizarro C. Predictive value of perioperative near-infrared spectroscopy for neurodevelopmental outcomes after cardiac surgery in infancy. J Thorac Cardiovasc Surg 2013; 145:438-445.e1; discussion 444-5. [DOI: 10.1016/j.jtcvs.2012.10.033] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 08/29/2012] [Accepted: 10/22/2012] [Indexed: 10/27/2022]
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Simons J, Sood ED, Derby CD, Pizarro C. Predictive value of near-infrared spectroscopy on neurodevelopmental outcome after surgery for congenital heart disease in infancy. J Thorac Cardiovasc Surg 2012; 143:118-25. [DOI: 10.1016/j.jtcvs.2011.09.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 07/19/2011] [Accepted: 09/15/2011] [Indexed: 11/15/2022]
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12
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Hessel EA. CNS Monitoring: The Current Weak State of the Evidence. J Cardiothorac Vasc Anesth 2011; 25:e15-6; author reply e16-7. [DOI: 10.1053/j.jvca.2010.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Indexed: 11/11/2022]
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13
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Surgical Management of Asymptomatic Carotid Stenosis. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Moritz S, Schmidt C, Bucher M, Wiesenack C, Zimmermann M, Schebesch KM, Kasprzak P, Metz C. Neuromonitoring in Carotid Surgery: Are the Results Obtained in Awake Patients Transferable to Patients Under Sevoflurane/Fentanyl Anesthesia? J Neurosurg Anesthesiol 2010; 22:288-95. [DOI: 10.1097/ana.0b013e3181e16e14] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pennekamp C, Bots M, Kappelle L, Moll F, de Borst G. The Value of Near-Infrared Spectroscopy Measured Cerebral Oximetry During Carotid Endarterectomy in Perioperative Stroke Prevention. A Review. Eur J Vasc Endovasc Surg 2009; 38:539-45. [DOI: 10.1016/j.ejvs.2009.07.008] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022]
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Denault A, Deschamps A, Murkin JM. A Proposed Algorithm for the Intraoperative Use of Cerebral Near-Infrared Spectroscopy. Semin Cardiothorac Vasc Anesth 2008; 11:274-81. [DOI: 10.1177/1089253207311685] [Citation(s) in RCA: 234] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Near-infrared spectroscopy (NIRS) is a technique that can be used as a noninvasive and continuous monitor of the balance between cerebral oxygen delivery and consumption. The authors develop and propose an algorithm for the use of NIRS based on optimizing factors that can affect cerebral oxygen supply/demand. These factors are the position of the vascular cannula, perfusion pressure, arterial oxygen content, partial pressure of carbon dioxide, haemoglobin, cardiac output, and the cerebral metabolic rate of oxygen. Dissemination of a useful treatment algorithm is the primary purpose of this article. Further multicenter studies are necessary to confirm the benefits and cost-effectiveness of this promising monitoring modality.
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Affiliation(s)
- André Denault
- Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec,
| | - Alain Deschamps
- Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec
| | - John M. Murkin
- Department of Anesthesiology and Perioperative Medicine, University Hospital, University of Western Ontario, London, Ontario Canada
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Lee DH, Choi JH, Lee DI, Choi YK. Changes in blood pressure, heart rate and regional cerebral oxygen saturation during the sitting position for shoulder arthroscopic surgery. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.1.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dong-hyun Lee
- Department of Anesthesiology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jeong-hyun Choi
- Department of Anesthesiology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Doo Ik Lee
- Department of Anesthesiology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Kyoo Choi
- Department of Anesthesiology, College of Medicine, Kyung Hee University, Seoul, Korea
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Piquette D, Deschamps A, Bélisle S, Pellerin M, Levesque S, Tardif JC, Denault AY. Effect of intravenous nitroglycerin on cerebral saturation in high-risk cardiac surgery. Can J Anaesth 2007; 54:718-27. [PMID: 17766739 DOI: 10.1007/bf03026868] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To determine whether or not intravenous nitroglycerin (IV NTG) can prevent a decrease in near-infrared spectroscopy (NIRS) values during cardiopulmonary bypass (CPB). METHODS We conducted a randomized double-blinded study in a tertiary academic center including 30 patients with a Parsonnet score>or=15 scheduled for a high-risk cardiac surgery. The patients were randomized to receive either IV NTG (initial dose of 0.05 microg.kg(-1).min(-1), followed by 0.1 microg.kg(-1).min(-1)) or placebo after anesthetic induction until the end of CPB. The primary outcome was a decrease of 10% in NIRS values during CPB. RESULTS Despite the absence of between-group difference in the mean cerebral oxygen saturation during CPB, there was a significant decrease in NIRS values during CPB in the placebo group, whereas mean NIRS values were maintained in the IV NTG group (-16.7% vs 2.3% in the NTG, P=0.019). Major hemodynamic variables were similar at corresponding time periods in both groups, while patients in the IV NTG group had higher CK-MB values and experienced greater blood loss during the first 24 hr postoperatively. CONCLUSION Intravenous nitroglycerin administration before and during CPB may prevent a decrease in NIRS values associated with CPB in high-risk cardiac surgery. Further studies are warranted to determine the efficacy and the risks associated with IV NTG infusion for this indication during CPB in high-risk patients.
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Affiliation(s)
- Dominique Piquette
- Department of Anesthesiology and Research Center, Montreal Heart Institute and Université de Montréal, 5000 Bélanger Street, Montréal, Québec H1T 1C8, Canada
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