The Effects of Carotid Endarterectomy Surgery on Cerebral Oxygenation, Randomized Clinical Trial

Yıl 2022, Cilt: 6 Sayı: 2, 143 - 149, 30.08.2022

Gonca Kaya Mert Onur Avcı , Oğuz Gündoğdu , Cemil İsbir , İclal Özdemir Kol , Sinan Gürsoy , Kenan Kaygusuz

https://doi.org/10.46332/aemj.1017231

Öz

Purpose: The aim of this study is to assess how NIRS values changed with cross-clamp (CC) duration in carotis endarterectomy (CEA) surgeries.

Materials and Methods: The study included 30 patients. Before induction of general anesthesia, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation (SpO₂), and regional oxygen saturation(rSO₂) values were recorded as right and left sides. The same parameters were recorded before the carotid CC, at the 3rd, 5th, and 10th minutes of the carotid CC, and at the 1st and 5th minutes after the cross-clamp removal postoperatively.

Results: When the rSO₂ values of the study participants were measured at different times, there was a significant difference (p<0.05) between the right-sided mean rSO₂ values of the patients who underwent right-sided surgery (n=11). There was also a significant difference (p<0.05) between the left-sided mean rSO₂ values of the patients who underwent left-sided surgery (n=19).

Conclusion: We discovered that there was a significant decrease in cerebral oxygen saturation during CC in patients who had CEA surgery under general anesthesia and that cerebral oxygen saturation reached or exceeded the basal value after the CC was opened. 

Anahtar Kelimeler

carotid endarterectomy, cerebral ischemia, near-infrared spectroscopy

Teşekkür

We thank all the members of the anesthesiology departments.

Karotis Endarterektomi Cerrahisinin Serebral Oksijenizasyon Üzerine Etkileri, Randomize Klinik Çalışma

Öz

Amaç: Bu çalışmanın amacı kross-klemp süresi ile Near Infrared Spektroskopi (NIRS) değerlerinin nasıl değiştiğini gözlemlemektir.

Araçlar ve Yöntem: Çalışmaya 30 hasta dahil edildi. Genel anestezi indüksiyonu öncesi sistolik kan basıncı (SKB), diyastolik kan basıncı (DKB), ortalama arter basıncı (OAB), kalp atım hızı (KAH) ve periferik oksijen satürasyonu (SpO₂) ve bölgesel oksijen saturasyonu (rSO₂) değerleri sağ ve sol taraf olarak kaydedildi. Aynı parametreler karotis KK öncesi, karotis KK başlangıcının 3. dakika, 5. dakika, 10. dakikasında, kros klemp kalktıktan sonra 1. ve 5. dakikada ve postoperatif olarak kaydedildi. 

Bulgular: Çalışmaya alınan ve sağ taraftan cerrahi geçiren (n:11) hastaların sağ taraf ortalama rSO₂ değerleri arası farklılık anlamlı bulundu (p<0.05). Çalışmaya alınan ve sol taraftan cerrahi geçiren (n=19) hastaların sol taraf ortalama rSO₂ değerleri arası farklılık anlamlı bulundu (p<0.05). Çalışmaya alınan hastaların hiçbirinde postoperatif nörolojik komplikasyon izlenmemiştir.

Sonuç: Sonuç olarak genel anestezi altında KEA cerrahisi yapılan hastalarda KK sırasında serebral oksijen satürasyonunda belirgin bir düşüş olduğunu, KK açılmasının ardından serebral oksijen saturasyonun bazal değere tekrar ulaştığını veya bazal değerin de üzerine çıktığını gözlemledik.

Anahtar Kelimeler

carotis endarterectomi, near-infrared spektroskopi, serebral iskemi

Kaynakça

• 1. Roger VL, Go AS, Lyoyd-Jones DM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011;123(4):18-209.
• 2. Silver FL, Mackey A, Clark WM, et al. Safety of stenting and endarterectomy by symptomatic status in the carotid revascularization endarterectomy versus stenting trial. Stroke. 2011;42(3):675-680.
• 3. Barnett HJM, Taylor DW, Haynes RB. Beneficial effect of carotid endarterectomy in symptomatic patients with highgrade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991;325(7):445-453.
• 4. Farrell B, Fraser A, Sandercock P, et al. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351(9113):1379-1387.
• 5. Vaniyapong T , Chongruksut W , Rerkasem K . Local versus general anaesthesia for carotid endarterectomy Cochrane Database Syst Rev. 2013;(12): CD000126.
• 6. Meershoek AJA, Waard DD, Trappenburg J, et al. Clinical Response to Procedural Stroke Following Carotid Endarterectomy: A Delphi Consensus Study. Eur J Vasc Endovasc Surg. 2021;62(3):350-357.
• 7. Rémy P, Benjamin P, Yann LT, et al. Predictive Factors of Silent Brain Infarcts after Asymptomatic Carotid Endarterectomy. Ann. Vasc. Surg. 2018;51:225-233.
• 8. Estruch-Pérez MJ, Barberá-Alacreu M, Ausina-Aguilar A, Soliveres-Ripoll J, Solaz-Roldán C, Morales-SuárezVarela MM. Bispectral index variations in patients with neurological deficits during awake carotid endarterectomy. Eur. J. Anaesthesiol. 2010;27(4):359-363.
• 9. Fu H, Fan L, Wang T. Perioperative neurocognition in elderly patients. Curr Opin Anaesthesiol. 2018;31(1):24-29.
• 10. Wu L, Zhao H, Weng H, Ma D. Lasting effects of general anesthetics on the brain in the young and elderly: “mixed picture” of neurotoxicity, neuroprotection and cognitive impairment. J. Anesth. 2019;33(2):321–335.
• 11. Kim W, Taw B, Yokosako S, et al. The future of non-invasive cerebral oximetry in neurosurgical procedures: A systematic review. MNI Open Research. 2018;2(3):3.
• 12. Redford D, Paidy S, Kashif F. Absolute and trend accuracy of a new regional oximeter in healthy volunteers during controlled hypoxia. Anesth. Analg. 2014;119(6):1315-1319.
• 13. Carlin RE, McGraw DJ, Calimlim JR, Mascia MF. The use of near-infrared cerebral oximetry in awake carotid endarterectomy. J. Clin. Anesth. 1998;10(2):109-113.
• 14. Pedrini L, Magnoni F, Sensi L, et al. Is Near-Infrared Spectroscopy a Reliable Method to Evaluate Clamping Ischemia during Carotid Surgery? Stroke Res Treat. 2012;2012:156975.
• 15. Radak D, Sotirovic V, Obradovic M, Isenovic ER. Practical use of near-infrared spectroscopy in carotid surgery. Angiology. 2014;65(9):769-772.
• 16. Mille T, Tachimiri ME, Klersy C, et al. Near-infrared spectroscopy monitoring during carotid endarterectomy: which threshold value is critical? Eur. J. Vasc. Endovasc. Surg. 2004;27(6):646-650.
• 17. Ritter JC, Green D, Slim H, Tiwari A, Brown J, Rashid H. The role of cerebral oximetry in combination with awake testing in patients undergoing carotid endarterectomy under local anaesthesia. Eur. J. Vasc. Endovasc. Surg. 2011;41(5):599-605.