title: A clinical evaluation of near-infrared cerebral oximetry in the awake patient to monitor cerebral perfusion during carotid endarterectomy.
abstract: OBJECTIVE
  To evaluate the relationship between continuous noninvasive monitoring of cerebral saturation (regional cerebral oxygen saturation [rSo2]) and occurrence of clinical and electroencephalographic (EEG) signs of cerebral ischemia during carotid cross-clamping.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifty ASA physical status II and III inpatients undergoing elective carotid endarterectomy with a cervical plexus block.
  
  
  METHODS
  rSo2 was continuously monitored throughout surgery, while an independent neurologist evaluated the occurrence of both clinical and EEG signs of cerebral ischemia induced during carotid cross-clamping.
  
  
  RESULTS
  rSo2 was recorded 1 and 3 minutes after clamping the carotid artery during a 3-minute clamping test. In 5 patients (10%), the carotid clamping test was associated with the occurrence of clinical and EEG signs of cerebral ischemia. All these patients were treated with the placement of a Javid shunt, which completely resolved the symptoms. In no patient was permanent neurological injury reported at hospital discharge. In 4 of these patients, EEG signs of cerebral ischemia were present at both observation times, and in one of them, the duration of cerebral ischemia was less than 2 minutes. The percentage rSo2 reduction from baseline during the carotid clamping test was 17% +/- 4% in patients requiring shunt placement and only 8% +/- 6% in those who did not require it (P = .01). A decrease in rSo2 15% or greater during the carotid clamping test was associated with a 20-fold increase in the odd for developing severe cerebral ischemia (odds ratio, 20; 95% confidence interval, 6.7-59.2) (P = .001); however, this threshold had a 44% sensitivity and 82% specificity, with only 94% negative predictive value.
  
  
  CONCLUSIONS
  Continuous rSo2 monitoring is a simple and noninvasive method that correlates with the development of clinical and EEG signs of cerebral ischemia during carotid cross-clamping; however, we could not identify an rSo2 threshold that can be used alone to predict the need for shunt placement because of the low sensitivity and specificity.
authors.affiliation: Department of Anesthesiology, Vita-Salute University of Milan, IRCCS San Raffaele Hospital, 20132 Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Rigamonti
authors.forename: Mara
authors.initials: M
authors.lastname: Scandroglio
authors.forename: Francesco
authors.initials: F
authors.lastname: Minicucci
authors.forename: Silvio
authors.initials: S
authors.lastname: Magrin
authors.forename: Andrea
authors.initials: A
authors.lastname: Carozzo
authors.forename: Andrea
authors.initials: A
authors.lastname: Casati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D001923:Brain Chemistry; D002545:Brain Ischemia / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003250:Constriction; D004569:Electroencephalography / Q000187:drug effects; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood; D019265:Spectroscopy, Near-Infrared; D014851:Wakefulness
chemical_list: D010100:Oxygen