Comparing Doppler Ultrasonography and Cerebral Oximetry as Indicators for Shunting in Carotid Endarterectomy
| Autor: | Andrea Lassnigg, Michael Skolka, Walter Plöchl, Martin Czerny, Marek Ehrlich, Georg Grubhofer |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Adult
Male Middle Cerebral Artery medicine.medical_specialty medicine.medical_treatment Ischemia Blood Pressure Carotid endarterectomy Central nervous system disease symbols.namesake Arteriovenous Shunt Surgical Internal medicine medicine.artery medicine Humans Oximetry cardiovascular diseases Mean Blood Flow Velocity Aged Endarterectomy Carotid Spectroscopy Near-Infrared business.industry Vascular disease Middle Aged medicine.disease Echocardiography Doppler Color Oxygen Shunting Anesthesiology and Pain Medicine Cerebrovascular Circulation Anesthesia Middle cerebral artery cardiovascular system symbols Cardiology Female business Doppler effect |
| Zdroj: | Anesthesia & Analgesia. 91:1339-1344 |
| ISSN: | 0003-2999 |
| DOI: | 10.1097/00000539-200012000-00006 |
| Popis: | To determine the thresholds of selective shunting in carotid endarterectomy during general anesthesia, we compared transcranial Doppler ultrasonography and cerebral oximetry (RSO2). During carotid cross-clamping, RSO2 and mean blood flow velocity in the middle cerebral artery (Vm,mca) was simultaneously monitored in 55 of 59 patients. A relative decrease in Vm,mca to20% of preclamp velocity was the indication for selective shunting. Three patients were shunted, two because of criteria of Vm,mca and one in which Vm,mca measurements were impossible. No postoperative neurological deficits occurred. During cross-clamping, both Vm,mca (42+/-16 vs. 26+/-12 cm/s; P0.001) and RSO2 (68+/-7% vs. 62+/-8%; P0.01) decreased and a significant correlation between %Vm,mca and DeltaRSO2 was found (R(2) = 0.40; P = 0.003). Decreases in RSO213% identified two patients later shunted; however, this threshold would have indicated unnecessary shunting in seven patients (false positives = 17%). Transcranial Doppler ultrasonography identified patients at risk for ischemia more accurately than RSO2. Relying on RSO2 alone would increase the number of unnecessary shunts because of the low specificity. Accepting higher decreases in RSO2 does not appear reasonable because it bears the risk of a low sensitivity. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|