Near-infrared spectroscopy (NIRS) is a technique that can be used as a noninvasive and continuous monitor of the balance between cerebral oxygen delivery and consumption. The authors develop and propose an algorithm for the use of NIRS based on optimizing factors that can affect cerebral oxygen supply/demand. These factors are the position of the vascular cannula, perfusion pressure, arterial oxygen content, partial pressure of carbon dioxide, haemoglobin, cardiac output, and the cerebral metabolic rate of oxygen. Dissemination of a useful treatment algorithm is the primary purpose of this article. Further multicenter studies are necessary to confirm the benefits and cost-effectiveness of this promising monitoring modality.
Shojima M., Watanabe E., Mayanagi Y.Cerebral blood oxygenation after cerebrospinal fluid removal in hydrocephalus measured by near infrared spectroscopy. Surg Neurol. 2004;62:312-318.
5.
Gracias VH, Guillamondegui OD, Stiefel MF, et al. Cerebral cortical oxygenation: a pilot study. J Trauma. 2004;56:469-472.
6.
Vernieri F., Tibuzzi F., Pasqualetti P., et al. Transcranial Doppler and near-infrared spectroscopy can evaluate the hemodynamic effect of carotid artery occlusion. Stroke . 2004;35:64-70.
7.
Taillefer MC , Denault AYCerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy. Can J Anaesth. 2005;52:79-87.
8.
Kurth CD, Steven JL, Montenegro LM, et al. Cerebral oxygen saturation before congenital heart surgery. Ann Thorac Surg. 2001;72:187-192.
9.
Hadolt I., Litscher G.Noninvasive assessment of cerebral oxygenation during high altitude trekking in the Nepal Himalayas (2850-5600 m). Neurol Res . 2003;25: 183-188.
10.
Casati A., Fanelli G., Pietropaoli P., et al. Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg. 2005; 101:740-747.
11.
Murkin JM, Adams SJ, Novick RJ, et al. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg.2007; 104:51-58.
12.
Wahr JA, Tremper KK, Samra S., Delpy DTNear-infrared spectroscopy: theory and applications. J Cardiothorac Vasc Anesth. 1996;10:406-418.
13.
Watzman HM, Kurth CD, Montenegro LM, Rome J., Steven JM, Nicolson SCArterial and venous contributions to near-infrared cerebral oximetry . Anesthesiology. 2000;93:947-953.
Murkin JMPerioperative detection of brain oxygenation and clinical outcomes in cardiac surgery. Semin Cardiothorac Vasc Anesth. 2004 ;8:13-14.
16.
Piquette D., Deschamps A., Belisle S., et al. Effect of intravenous nitroglycerin on cerebral saturation in high-risk cardiac surgery. Can J Anaesth. 2007;54:718-727.
17.
Madsen PL, Nielsen HB, Christiansen P.Well-being and cerebral oxygen saturation during acute heart failure in humans . Clin Physiol. 2000;20:158-164.
18.
Koike A., Itoh H., Oohara R., et al. Cerebral oxygenation during exercise in cardiac patients. Chest. 2004;125:182-190.
19.
Gottlieb EA , Fraser CD Jr, Andropoulos DB, Diaz LKBilateral monitoring of cerebral oxygen saturation results in recognition of aortic cannula malposition during pediatric congenital heart surgery. Paediatr Anaesth . 2006;16: 787-789.
20.
Rossi M., Tirotta CF, Lagueruela RG, Madril D.Diminished Blalock-Taussig shunt flow detected by cerebral oximetry . Paediatr Anaesth. 2007;17:72-74.
21.
Janelle GM, Mnookin S., Gravenstein N., Martin TD, Urdaneta F.Unilateral cerebral oxygen desaturation during emergent repair of a DeBakey type 1 aortic dissection: potential aversion of a major catastrophe . Anesthesiology. 2002;96:1263-1265.
22.
Sakaguchi G. , Komiya T., Tamura N., et al. Cerebral malperfusion in acute type A dissection: direct innominate artery cannulation. J Thorac Cardiovasc Surg. 2005;129:1190-1191.
23.
Hoksbergen AW, Legemate DA, Csiba L., Csáti G., Síró P., Fülesdi B.Absent collateral function of the circle of Willis as risk factor for ischemic stroke. Cerebrovasc Dis . 2003;16:191-198.
24.
Merkkola P. , Tulla H., Ronkainen A., et al. Incomplete circle of Willis and right axillary artery perfusion. Ann Thorac Surg. 2006;82:74-79.
25.
Aavramides EJ, Murkin JMThe effect of surgical dislocation of the heart on cerebral blood flow in the presence of a single, two-stage venous cannula during cardiopulmonary bypass. Can J Anaesth.1996;43:A36.
26.
Paton B., Pearcy WC, Swan H.The importance of the electroencephalogram during cardiac surgery with particular reference to superior vena caval obstruction. Surg Gynecol Obstet. 1960;111:197-201.
27.
Diephuis JC , Moons KG, Nierich AN, Bruens M., van Dijk D., Kalkman CJJugular bulb desaturation during coronary artery surgery: a comparison of off-pump and on-pump procedures. Br J Anaesth.2005;94:715-720.
28.
Yoon BW, Bae HJ, Kang DW, et al. Intracranial cerebral artery disease as a risk factor for central nervous system complications of coronary artery bypass graft surgery. Stroke. 2001;32:94-99.
29.
Caruso LJ, Gravenstein N., Janelle GM, Gabrielli A.Detection of oxygen delivery failure during cardiopulmonary bypass: an even earlier warning technique. J Cardiothorac Vasc Anesth . 2002;16:789.
30.
Longhi L., Valeriani V., Rossi S., De Marchi M., Egidi M., Stocchetti N.Effects of hyperoxia on brain tissue oxygen tension in cerebral focal lesions . Acta Neurochir Suppl. 2002;81:315-317.
31.
Flynn EP, Auer RNEubaric hyperoxemia and experimental cerebral infarction. Ann Neurol. 2002;52:566-572.
32.
Singhal AB, Dijkhuizen RM, Rosen BR, Lo EHNormobaric hyperoxia reduces MRI diffusion abnormalities and infarct size in experimental stroke. Neurology. 2002 ;58:945-952.
33.
Agardh CD, Zhang H., Smith ML, Siesjo BKFree radical production and ischemic brain damage: influence of postischemic oxygen tension. Int J Dev Neurosci. 1991; 9:127-138.
34.
Yao FSF , Tseng CC, Yu JHN.Relationship between ETCO2 and cerebral oxygen tension. Anesthesiology. 2000;93:A320.
35.
Kolb JC, Ainslie PN, Ide K., Poulin MJProtocol to measure acute cerebrovascular and ventilatory responses to isocapnic hypoxia in humans. Respir Physiol Neurobiol. 2004; 141:191-199.
Shann KG, Likosky DS, Murkin JM, et al. An evidence-based review of the practice of cardiopulmonary bypass in adults: a focus on neurologic injury, glycemic control, hemodilution, and the inflammatory response. J Thorac Cardiovasc Surg. 2006;132:283-290.
38.
Dernevik L. , Arvidsson S., William-Olsson G.Cerebral perfusion in dogs during pulsatile and non pulsatile extracorporeal circulation. J Cardiovasc Surg (Torino). 1985;26:32-35.
39.
Murkin JM, Farrar K.The influence of pulsatile vs non-pulsatile cardiopulmonary bypass on cerebral blood flow and cerebral metabolism. Anesthesiology . 1989;71:A41.
40.
Hoffman GMPro: near-infrared spectroscopy should be used for all cardiopulmonary bypass . J Cardiothorac Vasc Anesth. 2006;20:606-612.
41.
Edmonds HL Jr.Pro: All cardiac surgical patients should have intraoperative cerebral oxygenation monitoring. J Cardiothorac Vasc Anesth . 2006;20:445-449.
42.
Muehlschlegel S., Lobato EBCon: All cardiac surgical patients should not have intraoperative cerebral oxygenation monitoring. J Cardiothorac Vasc Anesth. 2006; 20:613-615.
43.
Davies LK, Janelle GMCon: All cardiac surgical patients should not have intraoperative cerebral oxygenation monitoring. J Cardiothorac Vasc Anesth . 2006; 20:450-455.
