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Huppert EL, Parnia S. Cerebral oximetry: a developing tool for monitoring cerebral oxygenation during cardiopulmonary resuscitation. Ann N Y Acad Sci 2021; 1509:12-22. [PMID: 34780070 DOI: 10.1111/nyas.14706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022]
Abstract
Despite improvements in cardiopulmonary resuscitation (CPR), survival and neurologic recovery after cardiac arrest remain very poor because of the impact of severe ischemia and subsequent reperfusion injury. As the likelihood of survival and favorable neurologic outcome decreases with increasing severity of ischemia during CPR, developing methods to measure the magnitude of ischemia during resuscitation, particularly cerebral ischemia, is critical for improving overall outcomes. Cerebral oximetry, which measures regional cerebral oxygen saturation (rSO2 ) by near-infrared spectroscopy, has emerged as a potentially beneficial marker of cerebral ischemia during CPR. In numerous preclinical and clinical studies, higher rSO2 during CPR has been associated with improved cardiac arrest survival and neurologic outcome. In this narrative review, we summarize the scientific rationale and validation of cerebral oximetry across populations and pathophysiologic states, discuss the evidence surrounding its use to predict return of spontaneous circulation, rearrest, and neurologic outcome, and provide suggestions for incorporation of cerebral oximetry into CPR practice.
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Affiliation(s)
- Elise L Huppert
- Critical Care and Resuscitation Research Center, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York
| | - Sam Parnia
- Critical Care and Resuscitation Research Center, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Grossman School of Medicine, New York University Langone Health, New York, New York.,Division of Pulmonary, Critical Care & Sleep Medicine, New York University Langone Health, New York, New York
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2
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Argüelles-Delgado P, Schwarz G. Letter to the Editor about the article published in Clinical Oral Investigations titled "Effect of hyperextension of the neck (rose position) on cerebral blood oxygenation in patients who underwent cleft palate reconstructive surgery: prospective cohort study using near-infrared spectroscopy" (Smarius BJA, Breugem CC, Boasson MP, Alikhil J, van Norden S, Mink van der Molen AB, de Graaff JG. Clin Oral Invest, https://doi.org/10.1007/s00784-019-03157-8). Clin Oral Investig 2021; 25:371-373. [PMID: 33057885 DOI: 10.1007/s00784-020-03636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Placido Argüelles-Delgado
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria.
| | - Gerhard Schwarz
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5, A-8036, Graz, Austria
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Yang CL, Lim SB, Peters S, Eng JJ. Cortical Activation During Shoulder and Finger Movements in Healthy Adults: A Functional Near-Infrared Spectroscopy (fNIRS) Study. Front Hum Neurosci 2020; 14:260. [PMID: 32733221 PMCID: PMC7362764 DOI: 10.3389/fnhum.2020.00260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/12/2020] [Indexed: 02/03/2023] Open
Abstract
Characterization of cortical activation patterns during movement of the upper extremity in healthy adults is helpful in understanding recovery mechanisms following neurological disorders. This study explores cortical activation patterns associated with movements of the shoulder and fingers in healthy adults using functional near-infrared spectroscopy (fNIRS). Twelve healthy right-handed participants were recruited. Two motor tasks (shoulder abduction and finger extension) with two different trial lengths (10 s and 20 s) were performed in a sitting position at a rate of 0.5 Hz. The hemodynamic response, as indicated by oxy-hemoglobin (HbO) and deoxy-hemoglobin (HbR), over both hemispheres was acquired using a 54-channel fNIRS system. We found a generalized bilateral cortical activation during both motor tasks with greater activation in the contralateral compared to the ipsilateral primary motor cortex. Particularly in the more medial part of the contralateral hemisphere, significant higher activation was found during the shoulder compared to finger movements. Furthermore, cortical activation patterns are affected not only by motor tasks but also by trial lengths. HbO is more sensitive to detect cortical activation during finger movements in longer trials, while HbR is a better surrogate to capture active areas during shoulder movement in shorter trials. Based on these findings, reporting both HbO and HbR is strongly recommended for future fNIRS studies, and trial lengths should be taken into account when designing experiments and explaining results. Our findings demonstrating distinct cortical activation patterns associated with shoulder and finger movements in healthy adults provide a foundation for future research to study recovery mechanisms following neurological disorders.
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Affiliation(s)
- Chieh-Ling Yang
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Shannon B Lim
- Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada.,Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sue Peters
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Centre, Vancouver, BC, Canada
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4
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Smarius BJA, Breugem CC, Boasson MP, Alikhil S, van Norden J, van der Molen ABM, de Graaff JC. Effect of hyperextension of the neck (rose position) on cerebral blood oxygenation in patients who underwent cleft palate reconstructive surgery: prospective cohort study using near-infrared spectroscopy. Clin Oral Investig 2020; 24:2909-2918. [PMID: 32219565 DOI: 10.1007/s00784-019-03157-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/13/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To facilitate the best approach during cleft palate surgery, children are positioned with hyperextension of the neck. Extensive head extension may induce intraoperative cerebral ischemia if collateral flow is insufficient. To evaluate and monitor the effect of cerebral blood flow on cerebral tissue oxygenation, near-infrared spectroscopy has proved to be a valuable method. The aim of this study was to evaluate and quantify whether hyperextension affects the cerebral tissue oxygenation in children during cleft palate surgery. MATERIALS AND METHODS This prospective study included children (ASA 1 and 2) under the age of 3 years old who underwent cleft palate repair at the Wilhelmina Children's Hospital, in The Netherlands. Data were collected for date of birth, cleft type, date of cleft repair, and physiological parameters (MAP, saturation, heart rate, expiratory CO2 and O2, temperature, and cerebral blood oxygenation) during surgery. The cerebral blood oxygenation was measured with NIRS. RESULTS Thirty-four children were included in this study. The majority of the population was male (61.8%, n = 21). The mixed model analyses showed a significant drop at time of Rose position of - 4.25 (69-74 95% CI; p < 0.001) and - 4.39 (69-74 95% CI; p < 0.001). Postoperatively, none of the children displayed any neurological disturbance. CONCLUSION This study suggests that hyperextension of the head during cleft palate surgery leads to a significant decrease in cerebral oxygenation. Severe cerebral desaturation events during surgery were uncommon and do not seem to be of clinical relevance in ASA 1 and 2 children. CLINICAL RELEVANCE There was a significant drop in cerebral oxygenation after positioning however it is not clear whether this drop is truly significant physiologically in ASA 1 and 2 patients.
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Affiliation(s)
- B J A Smarius
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. 85090, 3508 AB, Utrecht, The Netherlands.
| | - C C Breugem
- Department of Pediatric Plastic Surgery, Emma Children's Hospital, University Medical Center Amsterdam, Amsterdam, The Netherlands.,Department of Plastic Surgery, Meander Medical Center, Amersfoort, The Netherlands
| | - M P Boasson
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Alikhil
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J van Norden
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A B Mink van der Molen
- Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, P.O. 85090, 3508 AB, Utrecht, The Netherlands
| | - J C de Graaff
- Department of Anesthesia, University Medical Center Utrecht, Utrecht, The Netherlands. .,Department of Anesthesia, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
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Murniece S, Soehle M, Vanags I, Mamaja B. Near Infrared Spectroscopy Based Clinical Algorithm Applicability During Spinal Neurosurgery and Postoperative Cognitive Disturbances. ACTA ACUST UNITED AC 2019; 55:medicina55050179. [PMID: 31117234 PMCID: PMC6572416 DOI: 10.3390/medicina55050179] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/10/2019] [Accepted: 05/14/2019] [Indexed: 01/12/2023]
Abstract
Background and Objectives: Postoperative cognitive disturbances (POCD) can significantly alter postoperative recovery. Inadequate intraoperative cerebral oxygen supply is one of the inciting causes of POCD. Near-infrared spectroscopy (NIRS) devices monitor cerebral oxygen saturation continuously and can help to guide intraoperative patient management. The aim of the study was to evaluate the applicability of the NIRS-based clinical algorithm during spinal neurosurgery and to find out whether it can influence postoperative cognitive performance. Materials and Methods: Thirty four patients scheduled for spinal neurosurgery were randomized into a study group (n = 23) and a control group (n = 11). We monitored regional cerebral oxygen saturation (rScO2) throughout surgery, using a NIRS device (INVOS 4100). If rScO2 dropped bilaterally or unilaterally by more than 20% from baseline values, or under an absolute value of 50%, the NIRS-based algorithm was initiated in the study group. In the control group, rScO2 was monitored blindly. To evaluate cognitive function, Montreal-Cognitive Assessment (MoCA) scale was used in both groups before and after the surgery. Results: In the study group, rScO2 dropped below the threshold in three patients and the NIRS-based algorithm was activated. Firstly, we verified correct positioning of the head; secondly, we increased mean systemic arterial pressure in the three patients by injecting repeated intravenous bolus doses of Ephedrine, ultimately resulting in an rScO2 increase above the approved threshold level. None of the three patients showed POCD. In the control group, one patient showed a drop in rScO2 of 34% from baseline and presented with a POCD. RScO2 drop occurred with other stable intraoperative measurements. Conclusions: A significant rScO2 drop may occur during spinal surgery in prone position despite other intraoperative measurements remaining stable, allowing it to stay otherwise unrecognized. Use of the NIRS-based clinical algorithm can help to avoid POCD in patients after spinal surgery.
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Affiliation(s)
- Sniedze Murniece
- Department of Anesthesiology, Riga East Clinical University Hospital, Hipokrata Street 2, LV1038 Riga, Latvia.
- Department of doctoral studies, Riga Stradins University, Dzirciema Street 16, LV1007 Riga, Latvia.
| | - Martin Soehle
- Department of Anesthesiology, University Hospital of Bonn, Sigmund-Freud Str.25, 53105 Bonn, Germany.
| | - Indulis Vanags
- Department of doctoral studies, Riga Stradins University, Dzirciema Street 16, LV1007 Riga, Latvia.
- Department of Anesthesiology, Paul Stradins Clinical University Hospital, Pilsonu Street 13, LV1002 Riga, Latvia.
| | - Biruta Mamaja
- Department of Anesthesiology, Riga East Clinical University Hospital, Hipokrata Street 2, LV1038 Riga, Latvia.
- Department of doctoral studies, Riga Stradins University, Dzirciema Street 16, LV1007 Riga, Latvia.
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6
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Cerebral oxygen saturation monitoring during hypotensive anesthesia in shoulder arthroscopy: A comparative study between dexmedetomidine and esmolol. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2014.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Cerebral Tissue Oxygenation in Postural Changes in Mechanically Ventilated Preterm Newborns Less than 72 Hours after Birth. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.12405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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8
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Edmonds HL, Ganzel BL, Austin EH. Cerebral Oximetry for Cardiac and Vascular Surgery. Semin Cardiothorac Vasc Anesth 2017; 8:147-66. [PMID: 15248000 DOI: 10.1177/108925320400800208] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The technology of transcranial near-infrared spectroscopy (NIRS) for the measurement of cerebral oxygen balance was introduced 25 years ago. Until very recently, there has been only occasional interest in its use during surgical monitoring. Now, however, substantial technologic advances and numerous clinical studies have, at least partly, succeeded in overcoming long-standing and widespread misunderstanding and skepticism regarding its value. Our goals are to clarify common misconceptions about near-infrared spectroscopy and acquaint the reader with the substantial literature that now supports cerebral oximetric monitoring in cardiac and major vascular surgery.
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Affiliation(s)
- Harvey L Edmonds
- Department of Anesthesiology and Perioperative Medicine, University of Louisville School of Medicine, Louisville, Kentucky 40202-3619, USA.
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9
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Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study. Can J Anaesth 2016; 63:537-43. [DOI: 10.1007/s12630-016-0604-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/18/2015] [Accepted: 01/27/2016] [Indexed: 10/22/2022] Open
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Kocaoglu B, Ozgen SU, Toraman F, Karahan M, Guven O. Foreseeing the danger in the beach chair position: Are standard measurement methods reliable? Knee Surg Sports Traumatol Arthrosc 2015; 23:2639-44. [PMID: 24906434 DOI: 10.1007/s00167-014-3090-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 05/22/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study is to show whether peripheral perfusion monitoring methods reflect central perfusion during shoulder arthroscopy at beach chair position. We hypothesized that mean arterial pressure (MAP), central heart rate (CHR) and peripheral oxygenation (SaO2) measurements individually will not parallel cerebral oximetry measurements by near-infrared spectroscopy (NIRS). METHODS Between 2011 and 2012, 53 patients who had arthroscopic rotator cuff repair surgery in the beach chair position were enrolled prospectively. Median ages of the patients were 58 (range 42-68) years. The regional cerebral oxygen saturation value of each hemisphere was continuously monitored by the use of NIRS. MAP, CHR, SaO2 and both hemispheric cerebral oxygen saturation values were recorded at six time periods peri-operatively. Correlation and differences between parameters were evaluated. RESULTS Cerebral oxygen saturation of right hemisphere was dropped >20 % in 28.3 and 45.3 % of the patients. At left hemisphere, cerebral oxygen saturation was dropped >20 % in 20.8 and 43.4 % of the patients. Peripheral saturation values were statistically different from cerebral saturation values (p < 0.001). On the other hand, there was a correlation between cerebral saturation and MAP values (p < 0.05). CONCLUSION Cerebral oximetry by NIRS may prove useful as a monitor for cerebral ischaemia. In the absence of NIRS, CHR can partially detect abnormalities but not trustable, and MAP is the most reliable method for monitoring.
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Affiliation(s)
- Baris Kocaoglu
- Department of Orthopaedics and traumatology, Acibadem University Faculty of Medicine, Acibadem Kadikoy Hospital, Tekin Sok. No: 8, 34718, Acibadem, Istanbul, Turkey,
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11
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Changes in cerebral oxygen saturation following prone positioning for orthopaedic surgery under general anaesthesia. Eur J Anaesthesiol 2015; 32:381-6. [DOI: 10.1097/eja.0000000000000259] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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12
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Nielsen HB. Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery. Front Physiol 2014; 5:93. [PMID: 24672486 PMCID: PMC3955969 DOI: 10.3389/fphys.2014.00093] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 02/21/2014] [Indexed: 02/02/2023] Open
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.
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Affiliation(s)
- Henning B Nielsen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen Copenhagen, Denmark
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13
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Effect of head rotation during surgery in the prone position on regional cerebral oxygen saturation. Eur J Anaesthesiol 2014; 31:98-103. [DOI: 10.1097/eja.0000000000000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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14
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The effect of desflurane versus propofol on regional cerebral oxygenation in the sitting position for shoulder arthroscopy. J Clin Monit Comput 2013; 28:371-6. [DOI: 10.1007/s10877-013-9543-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
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15
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Salazar D, Sears BW, Andre J, Tonino P, Marra G. Cerebral desaturation during shoulder arthroscopy: a prospective observational study. Clin Orthop Relat Res 2013; 471:4027-34. [PMID: 23604602 PMCID: PMC3825914 DOI: 10.1007/s11999-013-2987-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/08/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients undergoing arthroscopic shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications as a result of cerebral ischemia. QUESTIONS/PURPOSES We sought to define the (1) incidence; (2) timing; and (3) magnitude of intraoperative cerebral desaturation events (CDEs) in subjects undergoing arthroscopic shoulder surgery in the beach chair position, as well as whether (4) the length of surgery was an independent risk factor for intraoperative CDEs. METHODS Regional cerebral tissue oxygen saturation (rSO2) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. Intraoperative decreases in rSO2 of 20% or greater were defined as CDEs. RESULTS The incidence of intraoperative CDEs in our series was 18% (nine of 51). Among the patients demonstrating CDE (n = 9), the mean time to onset of initial CDE was 18 minutes 38 seconds postinduction. Of those experiencing CDEs, the mean maximal decrease in rSO2 was 32% from preoperative baseline per patient. Additionally, the mean number of separate CDE instances was 1.89 in this patient population with an average duration of 3 minutes 3 seconds per instance. There was no statistically significant difference (p = 0.202) between patients demonstrating CDEs and those without in regard to length of surgery (95 versus 88 minutes). CONCLUSIONS The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with near-infrared spectroscopy allows prompt identification and treatment of decreased cerebral perfusion. We believe protocols aimed at detecting and reversing CDE may improve patient safety.
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Affiliation(s)
- Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL, 60153, USA,
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Zacharias DG, Lilly K, Shaw CL, Pirundini P, Rizzo RJ, Body SC, Longford NT. Survey of the clinical assessment and utility of near-infrared cerebral oximetry in cardiac surgery. J Cardiothorac Vasc Anesth 2013; 28:308-16. [PMID: 24140084 DOI: 10.1053/j.jvca.2013.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Near-infrared cerebral oximetry increasingly is used for monitoring during cardiac surgery. Nonetheless, the scientific basis for incorporating this technology into clinical practice, the indications for when to do so, and standard diagnostic and treatment algorithms for defining abnormal values are yet to be rigorously defined. The authors hypothesized that there would be (1) variation in clinical use and practices for near-infrared spectroscopy (NIRS), and (2) variation in management of patients when clinicians are provided with NIRS information. In order to test this hypothesis, they sought to assess the nature and strength of response heterogeneity among anesthesiologists and cardiac perfusionists when provided with cardiac surgery patient scenarios and cerebral oximetry data. DESIGN A prospectively collected survey. SETTING A hospital-based, multi-institutional, multinational study. PARTICIPANTS By e-mail, the authors surveyed the membership of the Society of Cardiovascular Anesthesiologists and the online Cardiovascular Perfusion Forum. INTERVENTIONS This survey was focused on ascertaining what actions clinicians would take in each scenario, given case information and cerebral oximetry tracings. Questions were based on 11 patient scenarios selected to represent small, large, symmetric, or asymmetric decreases in measured regional cerebral oxygen saturation (rScO2) encountered during cardiac surgery. Information on the respondents' (n = 796; 73% anesthesiologists) clinical practice, demography, and cerebral oximetry utilization was collected. An index of dispersion was used to assess response heterogeneity overall and within demographic subgroups. MEASUREMENTS AND MAIN RESULTS The majority of respondents indicated that cerebral oximetry monitoring was either useful or an essential monitor, especially perfusionists and clinicians who used cerebral oximetry most frequently. There were marked differences in responses between perfusionists and anesthesiologists for 4 of the 6 scenarios (p<0.005 for each of these 4 scenarios) occurring during cardiopulmonary bypass. Scenarios having greatest rScO2 reduction or asymmetry in rScO2 were associated with the highest dispersion, indicating least agreement in management. Scenarios with mild or moderate rScO2 reduction were associated with the lowest dispersion, indicating greater agreement in management. CONCLUSIONS Although experimental data gradually are accumulating to support the role for cerebral oximetry monitoring during cardiac surgery, the results of the present survey support the view that its role remains poorly defined, and consensus for its appropriate use is lacking. Importantly, the authors observed marked variation in the use, perceived utility, and management of patients for 4 of the 6 CPB scenarios between perfusionists and anesthesiologists who share the management of CPB. These findings support the need for well-designed, adequately-powered clinical trials examining the value of this technology.
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Affiliation(s)
- David G Zacharias
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | | | | | | | | | - Simon C Body
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Salazar D, Sears BW, Aghdasi B, Only A, Francois A, Tonino P, Marra G. Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects. J Shoulder Elbow Surg 2013; 22:1228-35. [PMID: 23415820 DOI: 10.1016/j.jse.2012.12.036] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 12/06/2012] [Accepted: 12/14/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients undergoing shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications due to cerebral ischemia. We sought to define the incidence, patient risk factors, and clinical sequelae of intraoperative cerebral desaturation events. METHODS Regional cerebral tissue oxygen saturation (rSO2) was monitored intra-operatively using near-infrared spectroscopy (NIRS) on 50 consecutive patients. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was administered to each patient pre- and postoperatively. Intra-operative decreases in rSO2 of 20% or greater were defined as cerebral desaturation events (CDE). The association between intraoperative CDE and postoperative cognitive decline was assessed. RESULTS The incidence of intraoperative CDE in our series was 18% (9/50). Increased body mass index (BMI) was found to have a statistically significant association with intraoperative CDE (mean BMI 37.32 vs 28.59, P < .0001). There was no statistical significance in pre- vs postoperative RBANS either in composite scores or any of the sub-indices in either group. CONCLUSION The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with NIRS allows prompt identification and treatment of decreased cerebral perfusion decreasing the risk of this event. Increased BMI was found to be a statistically significant patient risk factor for the development of intra-operative CDE. The transient intra-operative CDEs were not associated with postoperative cognitive dysfunction in our patient series. We believe protocols aimed at detecting and reversing CDE minimize the risk of neurocognitive dysfunction and improve patient safety.
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Affiliation(s)
- Dane Salazar
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, Maywood, IL 60153, USA.
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Curtin A, Izzetoglu K, Reynolds J, Menon R, Izzetoglu M, Osbakken M, Onaral B. Functional near-infrared spectroscopy for the measurement of propofol effects in conscious sedation during outpatient elective colonoscopy. Neuroimage 2013; 85 Pt 1:626-36. [PMID: 23850462 DOI: 10.1016/j.neuroimage.2013.07.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/30/2013] [Accepted: 07/03/2013] [Indexed: 12/27/2022] Open
Abstract
Endoscopic procedures performed in the United States routinely involve the use of conscious sedation as standard of care. The use of sedation reduces patient discomfort and anxiety while improving the technical quality of the procedure, and as a result, over 98% of clinicians have adopted the practice. The tremendous benefits of sedation are offset by heightened costs, increased patient discharge time, and cardiopulmonary complication risks. The inherent liabilities of putting patients under sedation have necessitated a large number of physiological monitoring systems in order to ensure patient comfort and safety. Currently American Society of Anesthesiologist (ASA) guidelines recommend monitoring of pulse oximetry, blood pressure, heart rate, and end-tidal CO2; although important safeguards, these physiological measurements do not allow for the reliable assessment of patient sedation. Proper monitoring of patient state ensures procedure quality and patient safety; however no "gold-standard" is available to determine the depth of sedation which is comparable to the anesthesiologist's professional judgment. Developments in functional near-infrared spectroscopy (fNIRS) over the past two decades have introduced cost-effective, portable, and non-invasive neuroimaging tools which measure cortical hemodynamic activity as a correlate of neural functions. Anesthetic drugs, such as propofol, operate by suppressing cerebral metabolism. fNIRS imaging methods have the ability to detect these drug related effects as well as neuronal activity through the measurement of local cerebral hemodynamic changes. In the present study, 41 patients were continuously monitored using fNIRS while undergoing outpatient elective colonoscopy with propofol sedation. The preliminary results indicated that oxygenated hemoglobin changes in the dorsolateral prefrontal cortex, as assessed by fNIRS were correlated with changes in response to bolus infusions of propofol, whereas other standard physiological measures were not significantly associated.
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Affiliation(s)
- Adrian Curtin
- School of Biomedical Engineering, Science & Health Systems, Drexel University, Philadelphia, PA, USA.
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Picton P, Ramachandran SK, Shanks A, Dorje P, Mashour GA. Optimizing cerebral oxygenation in anaesthetized patients with carotid artery stenosis: the influence of inspired oxygen fraction. Br J Anaesth 2012; 108:326-7. [PMID: 22250282 DOI: 10.1093/bja/aer466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lee JH, Min KT, Chun YM, Kim EJ, Choi SH. Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery. Arthroscopy 2011; 27:889-94. [PMID: 21620637 DOI: 10.1016/j.arthro.2011.02.027] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 01/17/2011] [Accepted: 02/15/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE We investigated the effects of the beach-chair position and induced hypotension on regional cerebral oxygen saturation (rSO(2)) in patients undergoing arthroscopic shoulder surgery by using near-infrared spectroscopy. METHODS Twenty-eight patients scheduled for arthroscopic shoulder surgery were enrolled prospectively. After induction of anesthesia, mechanical ventilation was controlled to maintain Paco(2) at 35 to 40 mm Hg. Anesthesia was maintained with sevoflurane and remifentanil. After radial artery cannulation, mean arterial pressure (MAP) was measured at the external auditory meatus level and maintained between 60 and 65 mm Hg. The rSO(2) was measured by use of near-infrared spectroscopy. MAP and rSO(2) were recorded at the following times: before induction (T(0)), immediately after induction (T(1) [baseline]), after beach-chair position (T(2)), immediately after induced hypotension (T(3)), 1 hour after induced hypotension (T(4)), and after supine position at the end of surgery (T(5)). Cerebral desaturation was defined as a reduction in rSO(2) to less than 80% of baseline value for 15 seconds or greater. RESULTS A total of 27 patients were evaluated until the end of this study. The MAP at T(2) was significantly lower than that at T(1). The MAP values at T(3) and T(4) were significantly lower than those at T(1) and T(2). The rSO(2) at T(2) was significantly lower than that at T(1). Unlike the pattern of change in the MAP, there was no additional decrease in rSO(2) at T(3) and T(4). There were 2 patients who had an episode of cerebral desaturation. CONCLUSIONS The beach-chair position combined with induced hypotension significantly decreases rSO(2) in patients undergoing shoulder arthroscopic surgery under general anesthesia. LEVEL OF EVIDENCE Level IV, study of nonconsecutive patients without consistently applied reference gold standard.
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Affiliation(s)
- Jae Hoon Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Nakagawa D, Ota T, Iijima A, Saito N. Diagnosis of Eagle Syndrome With 3-Dimensional Angiography and Near-Infrared Spectroscopy: Case Report. Neurosurgery 2011; 68:E847-9. [DOI: 10.1227/neu.0b013e318207ac74] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE:
Elongated styloid processes sometimes compress the cervical carotid artery, causing transient ischemic attacks. Most patients with Eagle syndrome who experience transient ischemic attacks have bilateral elongated styloid processes; therefore, it is necessary to determine which side is causing the Eagle syndrome to treat it. This is the first report of the usefulness of 3-dimensional angiography and near-infrared spectroscopy (NIRS) for the diagnosis of Eagle syndrome.
CLINICAL PRESENTATION:
A 40-year-old man experienced transient loss of consciousness when flexing his neck. On 3-dimensional computed tomography, bilateral elongated styloid processes were revealed. We were able to determine the side of concern using 3-dimensional angiography and NIRS. Three-dimensional angiography with his neck flexed showed a compressive dent in the cervical portion of the left internal carotid artery. On NIRS, during neck flexion, the concentrations of oxygenated hemoglobin and total hemoglobin decreased in his left motor area, which was resolved immediately when he returned his neck to its natural position. This led to decreased cerebral blood flow in the left hemisphere of his brain. After partial removal of left styloid process, he was symptom free, even when keeping his neck flexed. NIRS showed that the concentrations of oxygenated hemoglobin increased in the left motor area during neck flexion.
CONCLUSION:
We report the usefulness of 3-dimensional angiography and NIRS for diagnosing Eagle syndrome. Three-dimensional angiography and NIRS can visualize anatomic structures and provide hemodynamic information for an appropriate surgical strategy.
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Affiliation(s)
- Daichi Nakagawa
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Takahiro Ota
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Akira Iijima
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
| | - Nobuhito Saito
- Department of Neurosurgery, University of Tokyo, Tokyo, Japan
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Kwak HJ, Lee D, Lee YW, Yu GY, Shinn HK, Kim JY. The Intermittent Sequential Compression Device on the Lower Extremities Attenuates the Decrease in Regional Cerebral Oxygen Saturation During Sitting Position Under Sevoflurane Anesthesia. J Neurosurg Anesthesiol 2011; 23:1-5. [DOI: 10.1097/ana.0b013e3181e97a5e] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Murphy GS, Szokol JW, Marymont JH, Greenberg SB, Avram MJ, Vender JS, Vaughn J, Nisman M. Cerebral Oxygen Desaturation Events Assessed by Near-Infrared Spectroscopy During Shoulder Arthroscopy in the Beach Chair and Lateral Decubitus Positions. Anesth Analg 2010; 111:496-505. [DOI: 10.1213/ane.0b013e3181e33bd9] [Citation(s) in RCA: 191] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kaki AM, Almarakbi WA. Does Patient Position Influence the Reading of the Bispectral Index Monitor? Anesth Analg 2009; 109:1843-6. [DOI: 10.1213/ane.0b013e3181bce58d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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Lin CM, Wu CT, Lee ST, Lui TN, Huang CC, Li AHL, Doufas AG. Sitting position does not alter minimum alveolar concentration for desflurane. Can J Anaesth 2007; 54:523-30. [PMID: 17602037 DOI: 10.1007/bf03022315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Hypotension is a common complication of the sitting position during anesthesia, and is often counteracted by decreasing anesthetic depth, thereby exposing patients to the risk of being inadequately anesthetized. Baroreceptor unloading and the consequent sympathoexcitation, as during head up tilt, decreases pain threshold and arouses the central nervous system (CNS), whereas hypotension exerts a direct CNS depressant effect. We estimated the minimal alveolar concentration (MAC) of desflurane for immobility in patients undergoing surgery in the sitting position, in comparison to MAC desflurane for patients having a similar type of surgery in the supine position. METHODS The Dixon up-and-down method was used to evaluate the MAC for desflurane in patients undergoing cervical spine laminoplasty (n = 24) or discectomy (n = 24) in the sitting and supine positions, respectively. Logistic regression with co-variate adjustment was employed to examine if the two positions (sitting and supine) have different or share the same concentration vs response relationship for immobility. Monte Carlo simulation was used to calculate 95% confidence intervals (CI) for the MAC in each position, and to estimate the difference in MAC (delta MAC) between the sitting and supine positions. RESULTS Modeling both sitting [6.54% (6.50-6.66, 95% CI)] and supine [6.70 (6.55-6.81)] patients as having different MAC concentrations did not significantly improve our simplified model, which treats the two patient groups as one [6.61 (6.52-6.70), delta -2 log likelihood = 2.735, P = 0.098]. Mean delta MAC (95% CI) was -0.14 (-0.30, 0.03). CONCLUSION The sitting position does not change desflurane anesthetic requirements for immobility.
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Affiliation(s)
- Chun-Ming Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital, 5, Fu-Hsing St., Tao Yuan, Taiwan.
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Shinoura N, Yamada R. Dizziness is associated with decreased vasoreactivity in right cerebral hemisphere for head-down manoeuvre - near-infrared spectroscopy study. Clin Physiol Funct Imaging 2005; 25:16-9. [PMID: 15659075 DOI: 10.1111/j.1475-097x.2004.00586.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To investigate the vasoreactivity of cerebral hemisphere in patients with dizziness and syncope, we compared changes in total haemoglobin (THbl) and regional oxygen saturation (rSO2) of the right and left frontal lobes in response to head-down manoeuvre. Ninety-six right-handed subjects (aged 59 +/- 19 years) were asked to perform a head-down or a standing manoeuvre. Head-down manoeuvre produced a greater increase in right side THbl in subjects under 70 years of age (8.5 +/- 3.1) when compared with subjects older than 70 years (0.40 +/- 0.08). In contrast, the head-down manoeuvre had no effects on left side THbl, irrespective of patient age. Similarly, the head-down manoeuvre resulted in a greater decrease of right side rSO2 in subjects under 70 years of age (-5.2 +/- 2.1%) when compared with subjects older than 70 years (0.31 +/- 0.9%). In contrast, the head-down manoeuvre had no effects on left side rSO2, irrespective of patient age. The head-down manoeuvre produced a smaller increase in right side THbl in subjects with dizziness (0.38 +/- 0.19) than in those without dizziness (9.4 +/- 3.5). A standing manoeuvre produced a smaller increase in right side THbl in subjects with syncope (-0.057 +/- 0.047) than in those without syncope (0.063 +/- 0.028). The head-down manoeuvre produced a decrease in right side rSO2 in subjects without dizziness (-6.4 +/- 2.4%) and a slight increase in right side rSO2 in subjects with dizziness (1.1 +/- 0.4%). Subjects with dizziness (67 +/- 2.1 years) were significantly older than those without dizziness (53 +/- 2.7 years) or those with syncope (44 +/- 4.2 years). These data indicate that reduced vasoreactivity to right hemispheric pressure changes is associated with dizziness in older subjects. Further, decreases in right hemispheric THbl during a standing manoeuvre are associated with syncope in relatively younger subjects.
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Affiliation(s)
- Nobusada Shinoura
- Department of Neurosurgery, Komagome Metropolitan Hospital, Tokyo, Japan.
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Akça O, Sessler DI. Use of cerebral oximetry to detect and manage cerebral desaturation with a rapidly expanding neck hematoma. Acta Anaesthesiol Scand 2002; 46:607-8. [PMID: 12027858 DOI: 10.1034/j.1399-6576.2002.460521.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND We report a case in which cerebral oximetry was used to successfully demonstrate when cerebral oxygen saturation is dangerously low. METHODS In a 60-year-old-man with end-stage multiple myeloma and hyperviscosity syndrome, a rapidly expanding hematoma developed after insertion of an internal jugular central venous catheter. As the hematoma expanded, the patient became lethargic and disoriented (Glasgow Coma Score of E2/M4-5/V2-ETT). His platelet count was 17,000.mm(-3), hemoglobin was 4.5 g/dl, partial thromboplastin time was 51 s, and his international ratio was 1.7. Although carotid pulses became unpalpable, blood pressure and heart rate remained stable. Cerebral oximeter probes positioned on the patient's forehead showed that cerebral oxygen saturation was 22-26% bilaterally. The surgery team was advised to surgically evacuate the hematoma. RESULTS The hematoma was evacuated and a small needle hole in the right internal jugular vein adjacent to the central-venous catheter was found and repaired. Cerebral oxygen saturation increased to 56-58% within 1 h and stabilized near 60%. The patient awoke with normal cognitive function. CONCLUSION This case demonstrates how cerebral oximetry can be used to give quantitative evidence of cerebral hypoxia, thus showing that immediate surgical intervention is necessary.
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Affiliation(s)
- O Akça
- Outcomes Research Institute and Department of Anesthesiology, University of Louisville, KY 40202, USA.
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