The use of near-infrared cerebral oximetry in awake carotid endarterectomy

Journal of Clinical Anesthesia
R E CarlinM F Mascia

Abstract

To determine the utility of cerebral oximetry for monitoring the adequacy of cerebral blood flow (CBF) during carotid cross-clamp. Prospective study. University hospital. 16 consecutive ASA physical status III (or higher) patients for awake carotid endarterectomy (CEA). Regional cerebral oxygen saturation (SaO2) was monitored continuously during CEA, which was performed by the same surgeon, and with standard regional anesthetic, sedation, monitoring, and operative techniques. Data were recorded and analyzed using repeated measures analysis of variance (ANOVA). 14 hemodynamically stable patients demonstrated significant decreases in cerebral SaO2 from baseline: 69 + 1.8% to 64 + 1.2% at carotid cross-clamp (p < 0.001). After 5, 10, and 15-minute cross-clamp time, cerebral SaO2 was 63 + 1.4%, 64 + 1.5%, and 63 + 1.4%, respectively (p < 0.001, vs. baseline). On cross-clamp removal, cerebral SaO2 rose significantly: 67 + 1.6% (p < 0.01 vs. 5, 10, and 15 min). Two hypotensive patients (mean arterial pressures of 40 and 43 mmHg) developed signs and symptoms of global cerebral ischemia, with a concomitant decrease in cerebral oximetry (40% and 48%, respectively). These changes resolved with correction of hypotension. Cerebral SaO2 dec...Continue Reading

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Citations

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