title: Regional cerebral saturation versus transcranial Doppler during carotid endarterectomy under regional anaesthesia.
abstract: OBJECTIVE
  The aim of this study was to compare a cerebral oximeter with transcranial Doppler (TCD) as a neurological monitor in patients undergoing carotid endarterectomy under regional anaesthesia.
  
  
  METHODS
  Forty patients were enrolled for this prospective study. We recorded every adverse neurological event after arterial clamping and variations in parameters evaluated by the two monitoring systems in order to determine whether there was any correlation between TCD data and those obtained by regional cerebral saturation, the timing of detection of the adverse event in both clinical examination and instrumental data and the presence of any false positives or negatives in any of the two monitoring systems.
  
  
  RESULTS
  Shunting was necessary in eight patients, following clinical signs of a neurological deficit during clamping. In these patients, a significant reduction in TCD values and regional cerebral saturation values from baseline was recorded. We observed a drastic reduction in TCD values in four patients during clamping (6 +/- 5 versus 41 +/- 4 cm s) that was not associated with any neurological deficit or reduction in regional cerebral saturation values (51 +/- 4 versus 54 +/- 7%). Instrumental detection of a neurological deficit anticipated the clinical observation of about 5-10 s.
  
  
  CONCLUSIONS
  We observed a greater reliability with the cerebral oximeter than with TCD in our patients.
authors.affiliation: Dipartimento Scienze Anestesiologiche, Medicina Critica e Terapia del Dolore, Italy. mavif@tiscali.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Pugliese
authors.forename: Franco
authors.initials: F
authors.lastname: Ruberto
authors.forename: Antonella
authors.initials: A
authors.lastname: Tosi
authors.forename: Sabina
authors.initials: S
authors.lastname: Martelli
authors.forename: Katia
authors.initials: K
authors.lastname: Bruno
authors.forename: Deborah
authors.initials: D
authors.lastname: Summonti
authors.forename: Alessandra
authors.initials: A
authors.lastname: D'Alio
authors.forename: Beatrice
authors.initials: B
authors.lastname: Diana
authors.forename: Marco
authors.initials: M
authors.lastname: Anile
authors.forename: Antonietta
authors.initials: A
authors.lastname: Panico
authors.forename: Francesco
authors.initials: F
authors.lastname: Speziale
authors.forename: Paolo
authors.initials: P
authors.lastname: Pietropaoli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D001499:Bayes Theorem; D016893:Carotid Stenosis / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000187:drug effects / Q000502:physiology*; D004562:Electrocardiography; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D015203:Reproducibility of Results; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D010100:Oxygen