Cerebral Autoregulation Assessment through Near-Infrared Spectroscopy and Arterial Monitoring: Advancements and Clinical Implications

Year 2024, , 115 - 119, 28.07.2024

Muhammed Enes Aydin , Yunus Emre Karapınar , Berivan Bozan , Erkan Cem Çelik

https://doi.org/10.56766/ntms.1408031

Abstract

Cerebral autoregulation, maintaining stable cerebral blood flow across varying arterial pressures, is vital in-patient care during surgery. Traditional views suggest a mean arterial pressure range of 50-150 mm Hg for effective autoregulation. However, patient-specific variations in autoregulatory patterns, particularly in cases of impaired autoregulation, call for personalized hemodynamic and blood pressure management during surgical procedures.

In the evaluation of cerebral autoregulation, NIRS serves as a beneficial monitoring tool. The cerebral oximetry index, correlating cerebral oxygen saturation with perfusion pressure, aids in determining autoregulation limits. The literature shows varying impacts of vasoactive drugs on patients with different autoregulatory responses, emphasizing the need for individualized care.

In summary, NIRS is crucial for monitoring cerebral autoregulation, and adjusting arterial blood pressure targets based on NIRS data could improve prevention of cerebral hyper/hypoperfusion. This approach, moving away from a generalized strategy, advocates for a more customized, physiology-based patient management.

Keywords

Near Infrared Spectroscopy, Cerebral Oxymetry, Cerebral Autoregulation

References

• 1. Ferrari M, Giannini I, Sideri G, Zanette E. Continuous non invasive monitoring of human brain by near infrared spectroscopy. Adv Exp Med Biol. 1985; 191:873-82.
• 2. Krause M, Morabito JE, Mackensen GB, Perry TE, Bartels K. Current Neurologic Assessment and Neuroprotective Strategies in Cardiac Anesthesia: A Survey to the Membership of the Society of Cardiovascular Anesthesiologists. Anesth Analg. 2020; 131(2):518-26.
• 3. Roberts ML, Lin HM, Tinuoye E, et al. The Association of Cerebral Desaturation During One-Lung Ventilation and Postoperative Recovery: A Prospective Observational Cohort Study. J Cardiothorac Vasc Anesth. 2021; 35(2):542-50.
• 4. Laflam A, Joshi B, Brady K, et al. Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning: the anesthesia patient safety foundation beach chair study. Anesth Analg. 2015; 120(1):176-85.
• 5. Moerman A, De Hert S. Cerebral oximetry: the standard monitor of the future? Curr Opin Anaesthesiol. 2015;28(6):703-19.
• 6. Steppan J, Hogue CW, Jr. Cerebral and tissue oximetry. Best Pract Res Clin Anaesthesiol. 2014; 28(4):429-39.7
• 7. Moerman A, Wouters P. Near-infrared spectroscopy (NIRS) monitoring in contemporary anesthesia and critical care. Acta Anaesthesiol Belg. 2010; 61(4):185-94.
• 8. Huo C, Xu G, Xie H, Chen T, Shao G, Wang J, Li W, Wang D, Li Z. Functional near-infrared spectroscopy in non-invasive neuromodulation. Neural Regen Res. 2024; 19(7):1517-22.
• 9. Zhou X, Xia Y, Uchitel J, et al. Review of recent advances in frequency-domain near-infrared spectroscopy technologies. Biomed Opt Express. 2023; 14(7):3234-58.
• 10. Hassan HW, Mota-Silva E, Grasso V, Riehakainen L, Jose J, Menichetti L, Mirtaheri P. Near-Infrared Spectroscopy for the In Vivo Monitoring of Biodegradable Implants in Rats. Sensors (Basel). 2023; 23(4):2297.
• 11. Lassen NA. Cerebral blood flow and oxygen consumption in man. Physiol Rev Apr. 1959; 39(2):183-238.
• 12. Meng L, Hou W, Chui J, Han R, Gelb AW. Cardiac Output and Cerebral Blood Flow: The Integrated Regulation of Brain Perfusion in Adult Humans. Anesthesiology. 2015; 123(5):1198-208.
• 13. Vesoulis ZA, Mathur AM. Cerebral Autoregulation, Brain Injury, and the Transitioning Premature Infant. Front Pediatr. 2017; 5:64.
• 14. Meng L, Gelb AW. Regulation of cerebral autoregulation by carbon dioxide. Anesthesiology. 2015; 122(1):196-205.
• 15. Moerman AT, Vanbiervliet VM, Van Wesemael A, Bouchez SM, Wouters PF, De Hert SG. Assessment of Cerebral Autoregulation Patterns with Near-infrared Spectroscopy during Pharmacological-induced Pressure Changes. Anesthesiology. Ag 2015; 123(2):327-35.
• 16. Joshi B, Ono M, Brown C, et al. Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth Analg. 2012; 114(3):503-10.
• 17. Moerman A, De Hert S. Recent advances in cerebral oximetry. Assessment of cerebral autoregulation with near-infrared spectroscopy: myth or reality? F1000Res. 2017; 6:1615.
• 18. Brady KM, Lee JK, Kibler KK, et al. Continuous time-domain analysis of cerebrovascular autoregulation using near-infrared spectroscopy. Stroke. 2007; 38(10):2818-25.
• 19. Denault A, Deschamps A, Murkin JM. A proposed algorithm for the intraoperative use of cerebral near-infrared spectroscopy. Semin Cardiothorac Vasc Anesth. 2007; 11(4):274-81.
• 20. Demir A, Balcı E, Karadeniz Ü. Quick Evaluation of Cerebral Autoregulation Limits with Near Infrared Spectroscopic Techniques in the Intraoperative Period. Turk J Anaesthesiol Reanim. 2018; 46(4):316-18.
• 21. Holmgaard F, Vedel AG, Lange T, Nilsson JC, Ravn HB. Impact of 2 Distinct Levels of Mean Arterial Pressure on Near-Infrared Spectroscopy During Cardiac Surgery: Secondary Outcome From a Randomized Clinical Trial. Anesth Analg. 2019; 128(6):1081-88.