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Near infrared spectroscopy as a guide to surgical intervention during carotid endarterectomy

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Zogogiannis, I.; latrou, C.; Alexopoulos, C.; Voukena, V.; Vogiatzaki, T.; Lazarides, M. K.; Dimitriou, V.

European Journal of Anaesthesiology (EJA): June 2004 - Volume 21 - Issue - p 43
Monitoring: Equipment and Computers
Free

Department of Anaesthesia, G Gennimatas General Hospital, Athens, Greece

Goal of Study: Near infrared spectroscopy (NIRS) monitoring was used to define the need for shunting in patients undergoing carotid endarterectomy (CEA).

Methods: After board approval and patient informed consent 17 consecutive patients aged 50-80 yrs underwent CEA under general anaesthesia. Changes in ipsilateral and contralateral regional O2 saturation (rSO2) were monitored by NIRS. Heart rate, pulse oximetry and direct arterial blood pressure were continuously monitored and recorded in one minute intervals. Changes in rSO2 were recorded in absolute percent change. The relative decreases of rSO2 from baseline were calculated (absolute decrease in rSO2/baseline rSO2). A shunt was placed when rSO2 decrease was above 15%. The patients were evaluated neurologically and Ramsey and Sedation Agitation Scale (SAS) values were taken before induction and 15 min after emergence.

Results: Baseline rSO2 values varied significantly among patients (47-80%), and also between sides of an individual patient. The median duration of carotid cross clamping (CCC) was 63 min (range 4-110). In 7/17 (41%) patients the relative ipsilateral rSO2 change during CCC was 0-13% (0-10% in absolute values) and no shunt was used. After emergence there was no neurological deficit and they had SAS score 3-4 and Ramsey score 2-3. In 1/17 (6%) case the relative rSO2 change was 6% (0-10% absolute value) and no shunt was used. The patient had no neurological deficit but SAS score was 6 and Ramsey was 1. In 7/17 (41%) patients the relative ipsilateral rSO2 change during CCC was from 12% to 30% (5-12% in absolute values) and a shunt was placed. After emergence there was no neurological deficit and they had SAS score 3-4 and Ramsey score 2-3. In 1/17 (6%) patient the relative ipsilateral rSO2 change during CCC was 27% (10-12% in absolute values) and a shunt was placed. After emergence the patient had blurry speech and had SAS score 4 and Ramsey score 3. In 1/17 (6%) patient the relative ipsilateral rSO2 change during CCC was 20% (5-12% in absolute values) but the absolute value was 38 and a shunt was placed. After emergence the patient had no deficit with SAS score 4 and Ramsey score 2.

Conclusion: NIRS may prove a useful non-invasive diagnostic tool in early detecting intraoperative cerebral ischemia and guide to surgical interventions.

© 2004 European Society of Anaesthesiology