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Abstract

Reconstructive surgery on vessels supplying the brain and spinal cord frequently requires temporary interruption of blood flow, which entails cerebral hypoperfusion of a varying degree. The consequences of temporary cross-clamping range from almost unchanged to fully abolished perfusion to the corresponding region as blood flow is contingent on the availability and sufficiency of collateral circulation. Moreover, due to the minimal ischemic tolerance of the central nervous system (CNS), neurological deficits are dreaded complications in vascular surgery [15,17,41].

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References

  1. Amantini A, De Scisciolo G, Bartelli M, Lori S, Ronchi O, Pratesi C, Bertini D, Pinto F (1987) Selective shunting based on somatosensory evoked potential monitoring during carotid endarterectomy. Int Angiol 6:387–390

    PubMed  CAS  Google Scholar 

  2. Bashein G, Nessly M, Bledsoe S, Townes B, Davis K, Coppel D, Hornbein T (1992) Electroencephalography during surgery with cardiopulmonary bypass and hypothermia. Anesthesiology 76:878–891

    Article  PubMed  CAS  Google Scholar 

  3. Benichou H, Bergeron P, Ferdani M, Jausseran JM, Reggi M, Courbier R (1991) Pre-and intraoperative transcranial Doppler prediction and surveillance of tolerance to carotid clamping. Ann Vase Surg 1:21–25

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  5. Branston NM, Symon L, Crockard HA, Pasztor E (1974) Relationship between the cortical evoked potential and local cortical blood flow following acute middle cerebral artery occlusion in the baboon. Exp Neurol 45:195–208

    Article  PubMed  CAS  Google Scholar 

  6. Cherry KJ, Roland CF, Hallett JW, Gloviczki P, Bower TC, Toomey BJ, Pairolero PC (1991) Stump pressure, the contralateral carotid artery, and electroencephalographic changes. Am J Surg 162:185–189

    Article  PubMed  Google Scholar 

  7. Crawford ES, Mizrahi EM, Hess KR, Coselli JS, Safi HJ, Patel VM (1988) Thoracic and cardiovascular surgery. J Thorac Cardio vase Surg 95:357–367

    CAS  Google Scholar 

  8. Cunningham JN, Laschinger JC, Spencer FC (1987) Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. J Thorac Cardiovasc Surg 94:275–285

    PubMed  Google Scholar 

  9. Dinkel M, Kamp HD, Schweiger H (1991) Somatosensorisch evozierte Potentiale in der Karotischirurgie. Anaesthesist 40:72–78.

    PubMed  CAS  Google Scholar 

  10. Dinkel M, Schweiger H, Goerlitz P (1992) Monitoring during carotid surgery: somatosensory evoked potentials vs. carotid stump pressure. J Neurosurg Anesthesiol 4:167–175

    Article  PubMed  CAS  Google Scholar 

  11. Drenger B, Parker StD, McPherson RW, North RB, Williams GM, Reitz BA, Beattie C (1992) Spinal cord stimulation evoked potentials during thoracoabdominal aortic aneurysm surgery. Anesthesiology 76:689–695

    Article  PubMed  CAS  Google Scholar 

  12. Elmore JR, Gloviczki P, Harper M, Pairolero PC, Murray MJ, Bourchier RG, Bower TC, Daube JR (1991) Failure of motor evoked potentials to predict neurologic outcome in experimental thoracic aortic occlusion. J Vase Surg 14:131–139

    Article  CAS  Google Scholar 

  13. European Carotid Surgery Trialists Collaborative Groupe (1991) MRC European carotid surgery trial:interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:1235–1243

    Article  Google Scholar 

  14. Fava E, Bortolani EM, Ducati A, Ruberti U (1988) Evaluation of spinal cord function by means of lower limb somatosensory evoked potentials in reparative aortic surgery. J Cardiovasc Surg 29:421–427

    CAS  Google Scholar 

  15. Gewertz BL, McCaffrey MT (1987) Intraoperative monitoring during carotid endarterectomy. Curr Probl Surg 24:475–53

    Article  PubMed  CAS  Google Scholar 

  16. Gigli Gl, Caramia M, Marciani MG, Zarola F, Lavaroni F, Rossini PM (1987) Monitoring of subcortical and cortical somatosensory evoked potentials during carotid endarterectomy:comparison with stump pressure levels. Electroen- cephalogr Clin Neurophysiol 68:424–432

    Article  CAS  Google Scholar 

  17. Goto T, Crosby G (1992) Anesthesia and the spinal cord. In:Benumof JL, Bi- ssonette B. Cerebral protection, resuscitation, and monitoring. A look into the future of neuroanesthesia. Anesthesiol Clin N Am 10:493–519

    Google Scholar 

  18. Grabitz K, Freye E, Prior R, Sandmann W (1990) Protection of the spinal cord with prostaglandin (PGE 1) and prostacyclin (Iloprost) during aortic cross-clamping. Thorac Cardiovasc Surg 38:116

    Google Scholar 

  19. Grossi EA, Laschinger JC, Krieger KH, Nathan IM, Colvin SB, Weiss MR, Baumann FG (1988) Epidural-evoked potentials: a more specific indicator of spinal cord ischemia. J Surg Res 44:224–228

    Article  PubMed  CAS  Google Scholar 

  20. Gugino LD, Kraus KH, Heino R, Aglio LS, Levy WJ, Cohn L, Maddi R (1992) Peripheral ischemia as a complicating factor during somatosensory and motor evoked potential monitoring of aortic surgery. J Cardiothorac Vase Anesthes 6:715–719

    Article  CAS  Google Scholar 

  21. Halsey JH, McDowell HA, Gelmon S, Morawetz RB (1989) Blood velocity in the middle cerebral artery and regional cerebral blood flow during carotid endarterectomy. Stroke 20:53–58

    Article  PubMed  CAS  Google Scholar 

  22. Hanowell LH, Soriano S, Bennett HL (1992) EEG power changes are more sensitive than spectral edge frequency variation for detection of cerebral ischemia during carotid artery surgery:a prospective assessment of processed EEG monitoring. J Cardiothorac Vase Anesthes 6:292–294

    Article  CAS  Google Scholar 

  23. Kalkman CJ, Drummond JC, Ribberink AA, Patel PM, Sano T, Bickford RG (1992) Effects of propofol, etomidate, midazolam, and fentanyl on motor evoked responses to transcranial electrical or magnetic stimulation in humans. Anesthesiology 76:502–509

    Article  PubMed  CAS  Google Scholar 

  24. Kalkman CJ, Drummond JC, Kenelly NA, Patel PM, Partridge BL (1992) Intraoperative monitoring of tibialis anterior muscle motor evoked responses to transcranial electrical stimulation during partial neuromuscular blockade. Anesth Analg 75:584–589

    Article  PubMed  CAS  Google Scholar 

  25. Lam AM, Manninen PH, Ferguson GG, Nantau W (1991) Monitoring electro physiologic function during carotid endarterectomy:a comparison of somatosensory evoked potentials and conventional electroencephalogram. Anesthesiology 75:15–21

    Article  PubMed  CAS  Google Scholar 

  26. Lam AM (1992) Do evoked potentials have any value in anesthesia? In:Benumof JL, Bissonette B. Cerebral protection, resuscitation, and monitoring. A look into the future of neuroanesthesia. Anesthesiol Clin N Am 10:657–681

    Google Scholar 

  27. Larson CP, Ehrenfeld WK, Wade JG, Wylie EJ (1967) Jugular venous oxygen saturation as an index of adequacy of cerebral oxygenation. Surgery 62:31–39

    Google Scholar 

  28. Laschinger JC, Cunningham JN, Cooper MM, Krieger K, Nathan IM, Spencer FC (1984) Prevention of ischemic spinal cord injury following aortic cross-clamping: use of corticosteroids. Ann Thorac Surg 38:500–507

    Article  PubMed  CAS  Google Scholar 

  29. Laschinger JC, Cunningham JN, Cooper MM, Baumann FG, Spencer FC (1987) Monitoring of somatosensory evoked potentials during surgical procedures on the thoracoabdominal aorta. J Thorac Cardiovasc Surg 94:260–265

    PubMed  CAS  Google Scholar 

  30. Laschinger JC, Owen J, Rosenbloom M, Cox JL, Kouchoukos NT (1988) Direct non-invasive monitoring of spinal cord motor function during thoracic aortic occlusion: use of motor evoked potentials. J Vase Surg 7:161–171

    CAS  Google Scholar 

  31. Livesay JJ, Cooley DA, Ventemiglia RA, Montero CG, Warrian RK, Brown DM, Duncan JM (1985) Surgical experience in descending thoracic aneurysmectomy with and without adjuncts to avoid ischemia. Ann Thorac Surg 39:37–46

    Article  PubMed  CAS  Google Scholar 

  32. Maeda S, Miyamoto T, Murata H, Yamashita K (1989) Prevention of spinal cord ischemia by monitoring spinal cord perfusion pressure and somatosensory evoked potentials. J Cardiovasc Surg 30:565–570

    CAS  Google Scholar 

  33. McNulty St, Arkoosh V, Goldberg M (1991) The relevance of somatosensory evoked potentials during thoracic aorta aneurysm repair. J Cardiothorac Vase Anesthes 5:262–265

    Article  CAS  Google Scholar 

  34. Messick JM, Casement B, Sharbrough FW, Milde LN, Michenfelder JD, Sundt TM (1987) Correlation of regional cerebral blood flow (rCBF) with EEG changes during isoflurance anesthesia for carotid endarterectomy: critical rCBF. Anesthesiology 66:344–349

    Article  PubMed  Google Scholar 

  35. North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453

    Article  Google Scholar 

  36. Nugent M (1992) Pro cerebrospinal fluid drainage prevents paraplegia. J Cardiothorac Vase Anesth 6:366–368

    Article  CAS  Google Scholar 

  37. Nuwer MR (1988) Use of somatosensory evoked potentials for intraoperative monitoring of cerebral and spinal cord function. Neurol Clin 6:881–897

    PubMed  CAS  Google Scholar 

  38. Padayachee TS, Goslin RG, Lewis RR, Bishop CC, Browse NL (1987) Transcranial doppler assessment of cerebral collateral during carotid endarterectomy. Br J Surg 74:260–262

    Article  PubMed  CAS  Google Scholar 

  39. Robertson C, Narayan RK, Gokaslan ZL, Pahwa R, Grossmann RG, Caram P, Allen E (1989) Cerebral arteriovenous oxygen difference as an estimate of cerebral blood flow in comatose patients. J Neurosurg 70:222–230

    Article  PubMed  CAS  Google Scholar 

  40. Ruß W, Fraedrich G, Hehrlein FW, Hempelmann G (1985) Intraoperative somatosensory evoked potentials as a prognostic factor of neurologic state after carotid endarterectomy. Thorac Cardiovasc Surg 33:392–396

    Article  PubMed  Google Scholar 

  41. Shenaq SA, Svensson LG (1992) Con cerebrospinal fluid drainage does not afford spinal cord protection during resection of thoracic aneurysms. J Cardiothorac Vase Anesthes 6:369–372

    Article  CAS  Google Scholar 

  42. Spencer MP, Thomas GI, Moehring MA (1992) Relation between middle cerebral artery blood flow velocity and stump pressure during carotid endarterectomy. Stroke 23:1439–1445

    Article  PubMed  CAS  Google Scholar 

  43. Sundt TM, Sharbrough FW, Piepgra DG, Kearns TP, Messick JM, O’ Fallon WM (1981) Correlation of cerebral blood flow and electroencephalographic changes during carotid endarterectomy. Mayo Clin Proc 56:533–543

    PubMed  Google Scholar 

  44. Svensson LG, Von Ritter CM, Groeneveld HT, Rickards ES, Hunter SJS, Robinson MF, Hinder RA (1986) Cross-clamping of the thoracic aorta. Ann Surg 204:38–47

    Article  PubMed  CAS  Google Scholar 

  45. Thiel A, Russ W, Nestle HW, Hempelmann G (1989) Early detection transcranial dopplersonography and somatosensory evoked potentials. Thorac Cardiovasc Surg 37:115–118

    Article  PubMed  CAS  Google Scholar 

  46. Wade JG (1979) Anesthesia for carotid endarterectomy protection of brain vs protection of heart. ASA 30th Annual Refresher Course Lectures B 234

    Google Scholar 

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© 1994 Springer-verlag Berlin Heidelberg

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Dinkel, M., Lörler, H., Langer, H., Schweiger, H., Rügheimer, E. (1994). Evoked Potential Monitoring for Vascular Surgery. In: Schulte am Esch, J., Kochs, E. (eds) Central Nervous System Monitoring in Anesthesia and Intensive Care. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-78441-5_17

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  • DOI: https://doi.org/10.1007/978-3-642-78441-5_17

  • Publisher Name: Springer, Berlin, Heidelberg

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