Prevention of ischemic neurologic injury with intraoperative monitoring of selected cardiovascular and cerebrovascular procedures: roles of electroencephalography, somatosensory evoked potentials, transcranial Doppler, and near-infrared spectroscopy.
All neuromonitoring techniques, although imperfect, provide useful information for monitoring cardiothoracic and carotid vascular operations. They may be viewed as providing complementary information, which may help surgical technique and, as a result, possibly improve clinical outcomes. As of this writing, the efficacy of TCD and NIRS monitoring during cardiothoracic and vascular surgery cannot be considered established. Well designed, prospective, adequately powered, double-blind, and randomized outcome studies are needed to determine the optimal neurologic monitoring modality (or modalities), in specific surgical settings.
Sloan
Michael A
MA
Division of Neurology, Neuroscience and Spine Institute, Carolinas Medical Center, Charlotte, NC 28207, USA. michael.sloan@carolinashealthcare.org
D001921:Brain / Q000098:blood supply; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects*; D004569:Electroencephalography; D005073:Evoked Potentials, Somatosensory; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D019265:Spectroscopy, Near-Infrared; D017585:Ultrasonography, Doppler, Transcranial