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Cerebral Monitoring During Aortic Surgery

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Anesthesia and Perioperative Care for Aortic Surgery

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Abstract

Neurological complications occur frequently after aortic surgery and are associated with increased hospital mortality, and length of hospital and intensive care unit stay.

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References

  1. Poli de Figueiredo LF. Prevention and amelioration of neurologic dysfunction after complex aortic surgery: a task for critical care practitioners. Crit Care Med. 2004;32:1426–1427.

    Article  Google Scholar 

  2. Di Eusanio M, Schepens MA, Morshuis WJ, et al. Brain protection using antegrade selective cerebral perfusion: a multicenter study. Ann Thorac Surg. 2003;76:1181–1188.

    Article  PubMed  Google Scholar 

  3. Ehrlich MP, Ergin MA, McCullough JN, et al. Predictors of adverse outcome and transient neurological dysfunction after ascending aorta/hemiarch replacement. Ann Thorac Surg. 2000;69:1755–1763.

    Article  CAS  PubMed  Google Scholar 

  4. Fleck TM, Czerny M, Hutschala D, Koinig H, Wolner E, Grabenwoger M. The incidence of transient neurologic dysfunction after ascending aortic replacement with circulatory arrest. Ann Thorac Surg. 2003;76:1198–1202.

    Article  PubMed  Google Scholar 

  5. Tan ME, Morshuis WJ, Dossche KM, Kelder JC, Waanders FG, Schepens MA. Long-term results after 27 years of surgical treatment of acute type A aortic dissection. Ann Thorac Surg. 2005;80:523–529.

    Article  PubMed  Google Scholar 

  6. Ueda T, Shimizu H, Ito T, et al. Cerebral complications associated with selective perfusion of the arch vessels. Ann Thorac Surg. 2000;70:1472–1477.

    Article  CAS  PubMed  Google Scholar 

  7. Ergin MA, Uysal S, Reich DL, et al. Temporary neurological dysfunction after deep hypothermic circulatory arrest: a clinical marker of long-term functional deficit. Ann Thorac Surg. 1999;67:1887–1890.

    Article  CAS  PubMed  Google Scholar 

  8. Krahenbuhl ES, Immer FF, Stalder M, Englberger L, Eckstein FS, Carrel TP. Temporary neurological dysfunction after surgery of the thoracic aorta: a predictor of poor outcome and impaired quality of life. Eur J Cardiothorac Surg. 2008;33:1025–1029.

    Article  PubMed  Google Scholar 

  9. Erdos G, Tzanova I, Schirmer U, Ender J. Neuromonitoring and neuroprotection in cardiac anaesthesia. Nationwide survey conducted by the Cardiac Anaesthesia Working Group of the German Society of Anaesthesiology and Intensive Care Medicine. Anaesthesist. 2009;58:247–258.

    Article  CAS  PubMed  Google Scholar 

  10. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10:237–247.

    Article  CAS  PubMed  Google Scholar 

  11. Klem GH, Luders HO, Jasper HH, Elger C. The ten-twenty electrode system of the International Federation. The International Federation of Clinical Neurophysiology. Electroencephalogr Clin Neurophysiol Suppl. 1999;52:3–6.

    CAS  PubMed  Google Scholar 

  12. American Clinical Neurophysiology Society. Guideline 9D: guidelines on short-latency somatosensory evoked potentials. J Clin Neurophysiol. 2006;23:168–179.

    Article  Google Scholar 

  13. Banoub M, Tetzlaff JE, Schubert A. Pharmacologic and physiologic influences affecting sensory evoked potentials: implications for perioperative monitoring. Anesthesiology. 2003;99:716–737.

    Article  PubMed  Google Scholar 

  14. Richards CD. Actions of general anaesthetics on synaptic transmission in the CNS. Br J Anaesth. 1983;55:201–207.

    Article  CAS  PubMed  Google Scholar 

  15. Pathak KS, Ammadio M, Kalamchi A, Scoles PV, Shaffer JW, Mackay W. Effects of halothane, enflurane, and isoflurane on somatosensory evoked potentials during nitrous oxide anesthesia. Anesthesiology. 1987;66:753–757.

    Article  CAS  PubMed  Google Scholar 

  16. Peterson DO, Drummond JC, Todd MM. Effects of halothane, enflurane, isoflurane, and nitrous oxide on somatosensory evoked potentials in humans. Anesthesiology. 1986;65:35–40.

    Article  CAS  PubMed  Google Scholar 

  17. Samra SK, Vanderzant CW, Domer PA, Sackellares JC. Differential effects of isoflurane on human median nerve somatosensory evoked potentials. Anesthesiology. 1987;66:29–35.

    Article  CAS  PubMed  Google Scholar 

  18. Porkkala T, Kaukinen S, Hakkinen V, Jantti V. Median nerve somatosensory evoked potentials during isoflurane anaesthesia. Can J Anaesth. 1997;44:963–968.

    Article  CAS  PubMed  Google Scholar 

  19. Wolfe DE, Drummond JC. Differential effects of isoflurane/nitrous oxide on posterior tibial somatosensory evoked responses of cortical and subcortical origin. Anesth Analg. 1988;67:852–859.

    Article  CAS  PubMed  Google Scholar 

  20. Schindler E, Thiel A, Muller M, Milosevic M, Langer C, Hempelmann G. Changes in somatosensory evoked potentials after sevoflurane and isoflurane. A randomized phase III study. Anaesthesist. 1996;45(Suppl 1):S52–S56.

    CAS  PubMed  Google Scholar 

  21. Zhang J, Liang WM. Effects of volatile anesthetics on cortical somatosensory evoked potential and Bispectral index. Zhonghua Yi Xue Za Zhi. 2005;85:2700–2703.

    PubMed  Google Scholar 

  22. Rehberg B, Ruschner R, Fischer M, Ebeling BJ, Hoeft A. Concentration-dependent changes in the latency and amplitude of somatosensory-evoked potentials by desflurane, isoflurane and sevoflurane. Anästhesiol Intensivmed Notfallmed Schmerzther. 1998;33:425–429.

    Article  CAS  PubMed  Google Scholar 

  23. Schindler E, Muller M, Zickmann B, Osmer C, Wozniak G, Hempelmann G. Modulation of somatosensory evoked potentials under various concentrations of desflurane with and without nitrous oxide. J Neurosurg Anesthesiol. 1998;10:218–223.

    Article  CAS  PubMed  Google Scholar 

  24. McPherson RW, Sell B, Traystman RJ. Effects of thiopental, fentanyl, and etomidate on upper extremity somatosensory evoked potentials in humans. Anesthesiology. 1986;65:584–589.

    Article  CAS  PubMed  Google Scholar 

  25. Koht A, Schutz W, Schmidt G, Schramm J, Watanabe E. Effects of etomidate, midazolam, and thiopental on median nerve somatosensory evoked potentials and the additive effects of fentanyl and nitrous oxide. Anesth Analg. 1988;67:435–441.

    Article  CAS  PubMed  Google Scholar 

  26. Drummond JC, Todd MM, Hoi Sang U. The effect of high dose sodium thiopental on brain stem auditory and median nerve somatosensory evoked responses in humans. Anesthesiology. 1985;63:249–254.

    Article  CAS  PubMed  Google Scholar 

  27. Boisseau N, Madany M, Staccini P, et al. Comparison of the effects of sevoflurane and propofol on cortical somatosensory evoked potentials. Br J Anaesth. 2002;88:785–789.

    Article  CAS  PubMed  Google Scholar 

  28. Liu EH, Wong HK, Chia CP, Lim HJ, Chen ZY, Lee TL. Effects of isoflurane and propofol on cortical somatosensory evoked potentials during comparable depth of anaesthesia as guided by bispectral index. Br J Anaesth. 2005;94:193–197.

    Article  CAS  PubMed  Google Scholar 

  29. Clapcich AJ, Emerson RG, Roye DP Jr, et al. The effects of propofol, small-dose isoflurane, and nitrous oxide on cortical somatosensory evoked potential and bispectral index monitoring in adolescents undergoing spinal fusion. Anesth Analg. 2004;99:1334–1340.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Fung NY, Hu Y, Irwin MG, Chow BE, Yuen MY. Comparison between sevoflurane/remifentanil and propofol/remifentanil anaesthesia in providing conditions for somatosensory evoked potential monitoring during scoliosis corrective surgery. Anaesth Intensive Care. 2008;36:779–785.

    Article  CAS  PubMed  Google Scholar 

  31. Ku AS, Hu Y, Irwin MG, et al. Effect of sevoflurane/nitrous oxide versus propofol anaesthesia on somatosensory evoked potential monitoring of the spinal cord during surgery to correct scoliosis. Br J Anaesth. 2002;88:502–507.

    Article  CAS  PubMed  Google Scholar 

  32. Kalkman CJ, Leyssius AT, Bovill JG. Influence of high-dose opioid anesthesia on posterior tibial nerve somatosensory cortical evoked potentials: effects of fentanyl, sufentanil, and alfentanil. J Cardiothorac Anaesth. 1988;2:758–764.

    Article  CAS  Google Scholar 

  33. Schubert A, Drummond JC, Peterson DO, Saidman LJ. The effect of high-dose fentanyl on human median nerve somatosensory-evoked responses. Can J Anaesth. 1987;34:35–40.

    Article  CAS  PubMed  Google Scholar 

  34. Sloan TB, Fugina ML, Toleikis JR. Effects of midazolam on median nerve somatosensory evoked potentials. Br J Anaesth. 1990;64:590–593.

    Article  CAS  PubMed  Google Scholar 

  35. Sloan TB. Nondepolarizing neuromuscular blockade does not alter sensory evoked potentials. J Clin Monit. 1994;10:4–10.

    Article  CAS  PubMed  Google Scholar 

  36. Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev. 1959;39:183–238.

    Article  CAS  PubMed  Google Scholar 

  37. Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2:161–192.

    CAS  PubMed  Google Scholar 

  38. Florence G, Guerit JM, Gueguen B. Electroen­cephalography (EEG) and somatosensory evoked potentials (SEP) to prevent cerebral ischaemia in the operating room. Neurophysiol Clin. 2004;34:17–32.

    Article  PubMed  Google Scholar 

  39. Symon L. The relationship between CBF, evoked potentials and the clinical features in cerebral ischaemia. Acta Neurol Scand Suppl. 1980;78:175–190.

    CAS  PubMed  Google Scholar 

  40. Branston NM, Symon L, Crockard HA. Recovery of the cortical evoked response following temporary middle cerebral artery occlusion in baboons: relation to local blood flow and PO2. Stroke. 1976;7:151–157.

    Article  CAS  PubMed  Google Scholar 

  41. Matsumiya N, Koehler RC, Traystman RJ. Consistency of cerebral blood flow and evoked potential alterations with reversible focal ischemia in cats. Stroke. 1990;21:908–916.

    Article  CAS  PubMed  Google Scholar 

  42. Wilson GJ, Rebeyka IM, Coles JG, et al. Loss of the somatosensory evoked response as an indicator of reversible cerebral ischemia during hypothermic, low-flow cardiopulmonary bypass. Ann Thorac Surg. 1988;45:206–209.

    Article  CAS  PubMed  Google Scholar 

  43. Griepp RB, Ergin MA, Lansman SL, Galla JD, Pogo G. The physiology of hypothermic circulatory arrest. Semin Thorac Cardiovasc Surg. 1991 July;3:188–193.

    CAS  PubMed  Google Scholar 

  44. Svensson LG, Crawford ES, Hess KR, et al. Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg. 1993;106:19–28.

    Article  CAS  PubMed  Google Scholar 

  45. Ueda Y, Miki S, Kusuhara K, Okita Y, Tahata T, Yamanaka K. Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch, utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg (Torino). 1990;31:553–558.

    CAS  Google Scholar 

  46. Borst HG, Schaudig A, Rudolph W. Arteriovenous fistula of the aortic arch: repair during deep hypothermia and circulatory arrest. J Thorac Cardiovasc Surg. 1964;48:443–447.

    Article  CAS  PubMed  Google Scholar 

  47. Griepp RB, Stinson EB, Hollingsworth JF, Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975;70:1051–1063.

    CAS  PubMed  Google Scholar 

  48. Stecker MM, Cheung AT, Pochettino A, et al. Deep hypothermic circulatory arrest: II. Changes in electroencephalogram and evoked potentials during rewarming. Ann Thorac Surg. 2001;71:22–28.

    Article  CAS  PubMed  Google Scholar 

  49. Stecker MM, Cheung AT, Pochettino A, et al. Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg. 2001;71:14–21.

    Article  CAS  PubMed  Google Scholar 

  50. Coles JG, Taylor MJ, Pearce JM, et al. Cerebral monitoring of somatosensory evoked potentials during profoundly hypothermic circulatory arrest. Circulation. 1984;70(3 Pt 2):I96–I102.

    CAS  PubMed  Google Scholar 

  51. Guerit JM, Verhelst R, Rubay J, et al. The use of somatosensory evoked potentials to determine the optimal degree of hypothermia during circulatory arrest. J Card Surg. 1994;9:596–603.

    Article  CAS  PubMed  Google Scholar 

  52. Stecker MM. Neurophysiology of surgical procedures for repair of the aortic arch. J Clin Neurophysiol. 2007;24:310–315.

    PubMed  Google Scholar 

  53. Guerit JM, Baele P, de Tourtchaninoff M, Soveges L, Dion R. Somatosensory evoked potentials in patients undergoing circulatory arrest under profound hypothermia. Neurophysiol Clin. 1993;23:193–208.

    Article  CAS  PubMed  Google Scholar 

  54. Ghariani S, Matta A, Dion R, Guerit JM. Intra- and postoperative factors determining neurological complications after surgery under deep hypothermic circulatory arrest: a retrospective somatosensory evoked potential study. Clin Neurophysiol. 2000;111:1082–1094.

    Article  CAS  PubMed  Google Scholar 

  55. Ghariani S, Liard L, Spaey J, et al. Retrospective study of somatosensory evoked potential monitoring in deep hypothermic circulatory arrest. Ann Thorac Surg. 1999;67:1915–1918.

    Article  CAS  PubMed  Google Scholar 

  56. Sloan TB. Anesthetic effects on electrophysiologic recordings. J Clin Neurophysiol. 1998;15:217–226.

    Article  CAS  PubMed  Google Scholar 

  57. Sharbrough FW, Messick JM Jr, Sundt TM Jr. Correlation of continuous electroencephalograms with cerebral blood flow measurements during carotid endarterectomy. Stroke. 1973;4:674–683.

    Article  CAS  PubMed  Google Scholar 

  58. Blume WT, Ferguson GG, McNeill DK. Significance of EEG changes at carotid endarterectomy. Stroke. 1986;17:891–897.

    Article  CAS  PubMed  Google Scholar 

  59. Grady RE, Weglinski MR, Sharbrough FW, Perkins WJ. Correlation of regional cerebral blood flow with ischemic electroencephalographic changes during sevoflurane-nitrous oxide anesthesia for carotid endarterectomy. Anesthesiology. 1998;88:892–897.

    Article  CAS  PubMed  Google Scholar 

  60. Sundt TM Jr, Sharbrough FW, Piepgras DG, Kearns TP, Messick JM Jr, O’Fallon WM. Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy: with results of surgery and hemodynamics of cerebral ischemia. Mayo Clin Proc. 1981;56:533–543.

    PubMed  Google Scholar 

  61. Trojaborg W, Boysen G. Relation between EEG, regional cerebral blood flow and internal carotid artery pressure during carotid endarterectomy. Electroen­cephalogr Clin Neurophysiol. 1973;34:61–69.

    Article  CAS  PubMed  Google Scholar 

  62. Boysen G, Engell HC, Pistolese GR, Fiorani P, Agnoli A, Lassen NA. Editorial: on the critical lower level of cerebral blood flow in man with particular reference to carotid surgery. Circulation. 1974;49:1023–1025.

    Article  CAS  PubMed  Google Scholar 

  63. Safi HJ, Brien HW, Winter JN, et al. Brain protection via cerebral retrograde perfusion during aortic arch aneurysm repair. Ann Thorac Surg. 1993;56:270–276.

    Article  CAS  PubMed  Google Scholar 

  64. Hicks RG, Poole JL. Electroencephalographic changes with hypothermia and cardiopulmonary bypass in children. J Thorac Cardiovasc Surg. 1981;81:781–786.

    Article  CAS  PubMed  Google Scholar 

  65. Miller G, Rodichok LD, Baylen BG, Myers JL. EEG changes during open heart surgery on infants aged 6 months or less: relationship to early neurologic morbidity. Pediatr Neurol. 1994;10:124–130.

    Article  CAS  PubMed  Google Scholar 

  66. Mizrahi EM, Patel VM, Crawford ES, Coselli JS, Hess KR. Hypothermic-induced electrocerebral silence, prolonged circulatory arrest, and cerebral protection during cardiovascular surgery. Electroencephalogr Clin Neurophysiol. 1989;72:81–85.

    Article  CAS  PubMed  Google Scholar 

  67. Aaslid R, Markwalder TM, Nornes H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg. 1982;57:769–774.

    Article  CAS  PubMed  Google Scholar 

  68. ***Edmonds HL, Jr. Monitoring of cerebral perfusion with transcranial doppler ultrasound. In: Nuwer MR, ed. Intraoperative Monitoring of Neural Function: Handbook of neurophysiology.Vol 8, 1st ed. Elsevier, New York; 2008:909–923.

    Google Scholar 

  69. Halsey JH Jr. Risks and benefits of shunting in carotid endarterectomy. The International Transcranial Doppler Collaborators. Stroke. 1992;23:1583–1587.

    Article  PubMed  Google Scholar 

  70. Edmonds HL Jr, Thomas MH, Ganzel BL, Austin EH. Monitoring brain: transcranial Doppler. In: Coselli JS, Lemaire SA, eds. Aortic Arch Surgery, Principles, Strategies and Outcomes. 1st ed. Hoboken, NJ: Wiley-Blackwell; 2008:128–134.

    Chapter  Google Scholar 

  71. Greeley WJ, Ungerleider RM, Kern FH, Brusino FG, Smith LR, Reves JG. Effects of cardiopulmonary bypass on cerebral blood flow in neonates, infants, and children. Circulation. 1989;80(3 Pt 1):I209–I215.

    CAS  PubMed  Google Scholar 

  72. Neri E, Sassi C, Barabesi L, et al. Cerebral autoregulation after hypothermic circulatory arrest in operations on the aortic arch. Ann Thorac Surg. 2004;77:72–79.

    Article  PubMed  Google Scholar 

  73. Tanoue Y, Tominaga R, Ochiai Y, et al. Comparative study of retrograde and selective cerebral perfusion with transcranial Doppler. Ann Thorac Surg. 1999;67:672–675.

    Article  CAS  PubMed  Google Scholar 

  74. Appoo JJ, Augoustides JG, Pochettino A, et al. Perioperative outcome in adults undergoing elective deep hypothermic circulatory arrest with retrograde cerebral perfusion in proximal aortic arch repair: evaluation of protocol-based care. J Cardiothorac Vasc Anesth. 2006;20:3–7.

    Article  PubMed  Google Scholar 

  75. Estrera AL, Garami Z, Miller CC 3rd, et al. Cerebral monitoring with transcranial Doppler ultrasonography improves neurologic outcome during repairs of acute type A aortic dissection. J Thorac Cardiovasc Surg. 2005;129:277–285.

    Article  PubMed  Google Scholar 

  76. Ganzel BL, Edmonds HL Jr, Pank JR, Goldsmith LJ. Neurophysiologic monitoring to assure delivery of retrograde cerebral perfusion. J Thorac Cardiovasc Surg. 1997;113:748–755.

    Article  CAS  PubMed  Google Scholar 

  77. Doblar DD. Intraoperative transcranial ultrasonic monitoring for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth. 2004;8:127–145.

    Article  PubMed  Google Scholar 

  78. Fraser CD Jr, Andropoulos DB. Principles of antegrade cerebral perfusion during arch reconstruction in newborns/infants. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008;11:61–68.

    Article  Google Scholar 

  79. Pugsley W, Klinger L, Paschalis C, Treasure T, Harrison M, Newman S. The impact of microemboli during cardiopulmonary bypass on neuropsychological functioning. Stroke. 1994;25:1393–1399.

    Article  CAS  PubMed  Google Scholar 

  80. Kimatian SJ, Saliba KJ, Soler X, et al. The influence of neurophysiologic monitoring on the management of pediatric cardiopulmonary bypass. ASAIO J. 2008;54:467–469.

    Article  PubMed  Google Scholar 

  81. Spencer MP. Transcranial Doppler monitoring and causes of stroke from carotid endarterectomy. Stroke. 1997;28:685–691.

    Article  CAS  PubMed  Google Scholar 

  82. Calafiore AM, Bar-El Y, Vitolla G, et al. Early clinical experience with a new sutureless anastomotic device for proximal anastomosis of the saphenous vein to the aorta. J Thorac Cardiovasc Surg. 2001;121:854–858.

    Article  CAS  PubMed  Google Scholar 

  83. Eifert S, Reichenspurner H, Pfefferkorn T, et al. Neurological and neuropsychological examination and outcome after use of an intra-aortic filter device during cardiac surgery. Perfusion. 2003;18(Suppl 1):55–60.

    Article  PubMed  Google Scholar 

  84. McCullough TLA. Specialized neurophysiologic monitoring. In: Lake CL, Hines RL, Blitt CD, eds. Clinical Neuromonitoring. Practical Applications for Anesthesia and Critical Care. Philadelphia, PA: WB Saunders company; 2001:132–145.

    Google Scholar 

  85. Shaaban Ali M, Harmer M, Latto I. Jugular bulb oximetry during cardiac surgery. Anaesthesia. 2001;56:24–37.

    Article  CAS  PubMed  Google Scholar 

  86. McCullough JN, Zhang N, Reich DL, et al. Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg. 1999;67:1895–1899.

    Article  CAS  PubMed  Google Scholar 

  87. Greeley WJ, Kern FH, Ungerleider RM, et al. The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants, and children. J Thorac Cardiovasc Surg. 1991;101:783–794.

    Article  CAS  PubMed  Google Scholar 

  88. Mezrow CK, Midulla PS, Sadeghi AM, et al. Evaluation of cerebral metabolism and quantitative electroencephalography after hypothermic circulatory arrest and low-flow cardiopulmonary bypass at different temperatures. J Thorac Cardiovasc Surg. 1994;107:1006–1019.

    Article  CAS  PubMed  Google Scholar 

  89. Okada M, Sakakibara Y, Suehiro K, et al. Cerebral protection during aortic arch replacement: usefulness of continuous O2 saturation monitoring of internal jugular bulb to optimize cerebral perfusion. Kyobu Geka. 1993;46:668–671.

    CAS  PubMed  Google Scholar 

  90. Kuwabara M, Nakajima N, Yamamoto F, et al. Continuous monitoring of blood oxygen saturation of internal jugular vein as a useful indicator for selective cerebral perfusion during aortic arch replacement. J Thorac Cardiovasc Surg. 1992;103:355–362.

    Article  CAS  PubMed  Google Scholar 

  91. Ali MS, Harmer M, Vaughan RS, Dunne JA, Latto IP. Spatially resolved spectroscopy (NIRO-300) does not agree with jugular bulb oxygen saturation in patients undergoing warm bypass surgery. Can J Anaesth. 2001;48:497–501.

    Article  CAS  PubMed  Google Scholar 

  92. Ogino H, Ueda Y, Sugita T, et al. Monitoring of regional cerebral oxygenation by near-infrared spectroscopy during continuous retrograde cerebral perfusion for aortic arch surgery. Eur J Cardiothorac Surg. 1998;14:415–418.

    Article  CAS  PubMed  Google Scholar 

  93. McCormick PW, Stewart M, Goetting MG, Dujovny M, Lewis G, Ausman JI. Noninvasive cerebral optical spectroscopy for monitoring cerebral oxygen delivery and hemodynamics. Crit Care Med. 1991;19:89–97.

    Article  CAS  PubMed  Google Scholar 

  94. Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977;198:1264–1267.

    Article  CAS  PubMed  Google Scholar 

  95. Matcher SJ, Cope M, Delpy DT. Use of the water absorption spectrum to quantify tissue chromophore concentration changes in near-infrared spectroscopy. Phys Med Biol. 1994;39:177–196.

    Article  CAS  PubMed  Google Scholar 

  96. Germon TJ, Evans PD, Barnett NJ, Wall P, Manara AR, Nelson RJ. Cerebral near infrared spectroscopy: emitter-detector separation must be increased. Br J Anaesth. 1999;82:831–837.

    Article  CAS  PubMed  Google Scholar 

  97. Ohmae E, Ouchi Y, Oda M, et al. Cerebral hemodynamics evaluation by near-infrared time-resolved spectroscopy: correlation with simultaneous positron emission tomography measurements. Neuroimage. 2006;29:697–705.

    Article  PubMed  Google Scholar 

  98. Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology. 2000;93:947–953.

    Article  CAS  PubMed  Google Scholar 

  99. Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg. 2007;104:51–58.

    Article  PubMed  Google Scholar 

  100. Higami T, Kozawa S, Asada T, et al. A comparison of changes of cerebrovascular oxygen saturation in retrograde and selective cerebral perfusion during aortic arch surgery. Nippon Kyobu Geka Gakkai Zasshi. 1995;43:1919–1923.

    CAS  PubMed  Google Scholar 

  101. Hofer A, Haizinger B, Geiselseder G, Mair R, Rehak P, Gombotz H. Monitoring of selective antegrade cerebral perfusion using near infrared spectroscopy in neonatal aortic arch surgery. Eur J Anaesthesiol. 2005;22:293–298.

    Article  CAS  PubMed  Google Scholar 

  102. Orihashi K, Sueda T, Okada K, Imai K. Near-infrared spectroscopy for monitoring cerebral ischemia during selective cerebral perfusion. Eur J Cardiothorac Surg. 2004;26:907–911.

    Article  PubMed  Google Scholar 

  103. Juvonen T, Weisz DJ, Wolfe D, et al. Can retrograde perfusion mitigate cerebral injury after particulate embolization? A study in a chronic porcine model. J Thorac Cardiovasc Surg. 1998;115:1142–1159.

    Article  CAS  PubMed  Google Scholar 

  104. Boeckxstaens CJ, Flameng WJ. Retrograde cerebral perfusion does not perfuse the brain in nonhuman primates. Ann Thorac Surg. 1995;60:319–327. discussion 327–318.

    Article  CAS  PubMed  Google Scholar 

  105. Ehrlich MP, Hagl C, McCullough JN, et al. Retrograde cerebral perfusion provides negligible flow through brain capillaries in the pig. J Thorac Cardiovasc Surg. 2001;122:331–338.

    Article  CAS  PubMed  Google Scholar 

  106. Higami T, Kozawa S, Asada T, et al. Retrograde cerebral perfusion versus selective cerebral perfusion as evaluated by cerebral oxygen saturation during aortic arch reconstruction. Ann Thorac Surg. 1999;67:1091–1096.

    Article  CAS  PubMed  Google Scholar 

  107. Okita Y, Minatoya K, Tagusari O, Ando M, Nagatsuka K, Kitamura S. Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg. 2001;72:72–79.

    Article  CAS  PubMed  Google Scholar 

  108. Di Eusanio M, Schepens MA, Morshuis WJ, Di Bartolomeo R, Pierangeli A, Dossche KM. Antegrade selective cerebral perfusion during operations on the thoracic aorta: factors influencing survival and neurologic outcome in 413 patients. J Thorac Cardiovasc Surg. 2002;124:1080–1086.

    Article  PubMed  Google Scholar 

  109. Matalanis G, Hata M, Buxton BF. A retrospective comparative study of deep hypothermic circulatory arrest, retrograde, and antegrade cerebral perfusion in aortic arch surgery. Ann Thorac Cardiovasc Surg. 2003;9:174–179.

    PubMed  Google Scholar 

  110. Olsson C, Thelin S. Regional cerebral saturation monitoring with near-infrared spectroscopy during selective antegrade cerebral perfusion: diagnostic performance and relationship to postoperative stroke. J Thorac Cardiovasc Surg. 2006;131:371–379.

    Article  PubMed  Google Scholar 

  111. Sakaguchi G, Komiya T, Tamura N, et al. Cerebral malperfusion in acute type A dissection: direct innominate artery cannulation. J Thorac Cardiovasc Surg. 2005;129:1190–1191.

    Article  PubMed  Google Scholar 

  112. Janelle GM, Mnookin S, Gravenstein N, Martin TD, Urdaneta F. Unilateral cerebral oxygen desaturation during emergent repair of a DeBakey type 1 aortic dissection: potential aversion of a major catastrophe. Anesthesiology. 2002;96:1263–1265.

    Article  PubMed  Google Scholar 

  113. Schneider F, Falk V, Walther T, Mohr FW. Control of endoaortic clamp position during Port-Access mitral valve operations using transcranial Doppler echography. Ann Thorac Surg. 1998;65:1481–1482.

    Article  CAS  PubMed  Google Scholar 

  114. Orihashi K, Sueda T, Okada K, Imai K. Malposition of selective cerebral perfusion catheter is not a rare event. Eur J Cardiothorac Surg. 2005;27:644–648.

    Article  PubMed  Google Scholar 

  115. Hoksbergen AW, Legemate DA, Csiba L, Csati G, Siro P, Fulesdi B. Absent collateral function of the circle of Willis as risk factor for ischemic stroke. Cerebrovasc Dis. 2003;16:191–198.

    Article  CAS  PubMed  Google Scholar 

  116. Merkkola P, Tulla H, Ronkainen A, et al. Incomplete circle of Willis and right axillary artery perfusion. Ann Thorac Surg. 2006;82:74–79.

    Article  PubMed  Google Scholar 

  117. Santo KC, Barrios A, Dandekar U, Riley P, Guest P, Bonser RS. Near-infrared spectroscopy: an important monitoring tool during hybrid aortic arch replacement. Anesth Analg. 2008;107:793–796.

    Article  PubMed  Google Scholar 

  118. Leyvi G, Bello R, Wasnick JD, Plestis K. Assessment of cerebral oxygen balance during deep hypothermic circulatory arrest by continuous jugular bulb venous saturation and near-infrared spectroscopy. J Cardiothorac Vasc Anesth. 2006;20:826–833.

    Article  PubMed  Google Scholar 

  119. Yoshitani K, Kawaguchi M, Iwata M, et al. Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia. Br J Anaesth. 2005;94:341–346.

    Article  CAS  PubMed  Google Scholar 

  120. Stockard J, Bickford R. The neurophysiology of anesthesia. In: Gordon E, ed. A Basis and Practice of Neuroanesthesia. Amsterdam: Excerpta Medica; 1975:3–46.

    Google Scholar 

  121. McCullough JN, Galla JD, Ergin MA, Griepp RB. Central nervous system monitoring during operations on the thoracic aorta. Op Tech Thorac Cardiovasc Surg. 1999;1:87–96.

    Article  Google Scholar 

  122. Denault A, Deschamps A, Murkin JM, et al. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007;11:274–281.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Parthasarathy D. Thirumala

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  1. Parthasarathy D. Thirumala
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  2. John M. Murkin
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  3. Donald J. Crammond
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  4. Miguel Habeych
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  5. Jeffery Balzer
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  6. Kathirvel Subramaniam
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Correspondence to Parthasarathy D. Thirumala .

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Editors and Affiliations

  1. University of Pittsburgh Medical Center, Presbyterian Hospital, Clinical Assistant Professor, Pittsburgh, 15213-2582, Pennsylvania, USA

    Kathirvel Subramaniam

  2. Physician Director of Perioperative Serv, Professor of Clinical Anesthesia and of, Associate Vice President, Columbus, 43210, Ohio, USA

    Kyung W. Park

  3. Harvard Medical School, Director, Division of Cardiovascular Ane, Assistant Professor in Anesthesia, Boston, 02215, Massachusetts, USA

    Balachundhar Subramaniam

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Thirumala, P.D., Murkin, J.M., Crammond, D.J., Habeych, M., Balzer, J., Subramaniam, K. (2011). Cerebral Monitoring During Aortic Surgery. In: Subramaniam, K., Park, K., Subramaniam, B. (eds) Anesthesia and Perioperative Care for Aortic Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-85922-4_8

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