The effect of normotensive arterial pressure on cerebral saturation during carotid endarterectomy

Yıl 2021, Cilt: 4 Sayı: 2, 181 - 185, 28.03.2021

Cihan Yücel Nihan Kayalar

https://doi.org/10.32322/jhsm.863956

Öz

Aim: Monitoring of cerebral perfusion during carotid endarterectomy helps to institute early intervention to prevent risk of ischemia during the operation.
We aimed to evaluate if the disadvantages of high systemic pressure can be avoided by keeping arterial blood pressure below 150mmHg during cross-clamping of the internal carotid artery by correlating our findings of NIRS values with clinical results
Material and Method: This was designed as a prospective study that included elective patients scheduled for an operation of carotid artery stenosis under general anesthesia. A total of 60 patients operated on between August and October 2019 were included in the study.
Results: Patients' NIRS findings on the right and left hemispheres were analyzed separately to be able to differentiate any possible changes of NIRS of the cerebral hemisphere ipsilateral to the clamped carotid artery. The analysis of the right and left NIRS findings in these 60 patients revealed a significant decrease between intubation and incision NIRS values (p=0.008 and p= 0.02respectively).
Conclusion: Considering the NIRS findings and clinical observations of the patients in the postoperative period, we think that ICA endarterectomy operations may be safe to perform in a suitable patient group while the systolic arterial blood pressure is maintained below 150mmHg during cross-clamping.

Anahtar Kelimeler

Carotid endarterectomy, Stroke, Near-infrared spectroscopy

Kaynakça

• Morris DR, Ayabe K, Inoue T, et al. Evidence-based carotidinterventions for stroke prevention: state-of-the-art review. J Atheroscler Thromb 2017; 24: 373–87.
• Lee J, Huh U, Song S, Chung SW, Sung SM, Cho HJ. Regional anesthesia with dexmedetomidine ınfusion: a feasible method for the awake test during carotid endarterectomy. Ann Vasc Dis 2016; 9: 295-9
• Lam AM, Kianpour D. Monitoring for carotid endarterectomy: more or less? Anesth Analg 2015; 120: 1186–88.
• Maillard J, Sologashvili T, Diaper J, Licker MJ, Barcelos GK. A case of persistence of normal tissue oxygenation monitored by near-infraredspectroscopy (NIRS) values despite prolonged perioperative cardiac arrest. Am J Case Rep 2019; 20: 21–5
• Hirofumi O, Otone E, Hiroshi I, et al. The effectiveness of regional cerebral oxygen saturation monitoring using near-infrared spectroscopy in carotid endarterectomy. J Clin Neurosci 2003; 10: 79-83.
• Liu B, Wei W, Wang Y, Yang X, Yue S, Zhang J. Treatment strategy for bilateral severe carotid artery stenosis: one center's experience. World Neurosurg 2015; 84: 820–5.
• Barrett KM, Brott TG. Stroke caused by extracranial disease. Circ Res 2017; 120: 496–501.
• Li J, Shalabi A, Ji F, Meng L. Monitoring cerebral ischemia during carotid endarterectomy and stenting. J Biomed Res 2016; 31.
• Kragsterman B, Parsson H, Bergqvist D. Local haemodynamic changes during carotidendarterectomy-the influence on cerebral oxygenation. Eur J Vasc Endovasc Surg 2004; 27: 398-402.
• Pennekamp CW, Immink RV, den Ruijter HM, et al. Near-infrared spectroscopy to indicateselective shunt use during carotid endarterectomy. Eur J Vasc Endovasc Surg 2013; 46: 397-403.
• Cho JW, Jang JS. Near-ınfrared spectroscopy versus transcranial Doppler-based monitoring in carotid endarterectomy. Korean J Thorac Cardiovasc Surg 2017; 50: 448-52.
• Wang Y, Li L, Wang T, et al. The efficacy of near-infrared spectroscopy monitoring in carotid endarterectomy: a prospective, single-center, observational study. Cell Transplan 2019; 28: 170-5.
• Findlay JM, Kesarwani R, Jacka M, Marchak BE. Combined stump pressure and oximetry for shunt use during carotid endarterectomy. Can J Neurol Sci 2017; 44: 692–6.
• David J, Zhangjie Su, Michael T, et al. Near-infrared spectroscopy in the monitoring of adult traumatic brain injury: a review. J Neurotrauma 2015; 32: 933–41.
• Jonsson M, Lindström D, Wanhainen A, Gidlund KD, Gillgren P. Near ınfrared spectroscopy as a predictor for shunt requirement during carotid endarterectomy. Eur J Vasc Endovasc Surg 2017; 53: 783-91.
• Heyer EJ, Mergeche JL, Anastasian ZH, Kim M, Mallon KA, Connolly ES. Arterial blood pressure management during carotid endarterectomy and early cognitive dysfunction. Neurosurgery 2014; 74: 245-53.