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Applied neuromonitoring in cardiac surgery: patient specific management
1Department of Anesthesiology and Perioperative Medicine (Clinical Fellow), University of Western Ontario, London, Ontario.
Insights
Neuromonitoring techniques like bispectral index (BIS), transcranial Doppler (TCD), and near-infrared spectroscopy (NIRS) can optimize cerebral perfusion during cardiac surgery. This may reduce central nervous system (CNS) injury in patients with cerebrovascular disease.
Area of Science:
- Cardiovascular Surgery
- Neuroscience
- Medical Technology
Background:
- Over 50% of patients undergoing coronary revascularization have cerebrovascular atherosclerotic disease.
- Cerebral emboli and altered cerebral perfusion significantly contribute to perioperative central nervous system (CNS) morbidity.
- Optimizing CNS perfusion may mitigate microembolic injury.
Purpose of the Study:
- To critically evaluate applied neuromonitoring techniques in cardiac surgery patients.
- To discuss the characteristics of bispectral index (BIS), transcranial Doppler (TCD), and near-infrared reflectance spectroscopy (NIRS).
- To review recent outcomes data on CNS morbidity and the influence of neuromonitoring.
Main Methods:
- Review of existing literature on neuromonitoring in cardiac surgery.
- Analysis of characteristics of BIS, TCD, and NIRS.
- Evaluation of recent outcomes data regarding CNS morbidity.
Main Results:
- Neuromonitoring techniques aim to optimize cerebral perfusion characteristics.
- Applied neuromonitoring may lead to improved CNS outcomes in cardiac surgery.
- Specific techniques like BIS, TCD, and NIRS have roles in managing perioperative CNS risk.
Conclusions:
- Neuromonitoring is crucial for managing perioperative CNS risk in cardiac surgery patients with cerebrovascular disease.
- Optimization of cerebral perfusion through neuromonitoring can potentially ameliorate microembolic injury.
- Further evaluation of outcomes data is necessary to fully understand the impact of neuromonitoring.
Abstract:
Various studies have demonstrated that over 50% of patients presenting for coronary revascularization surgery have evidence of extracranial or intracranial atherosclerotic disease. Although evidence is compelling that cerebral emboli are a major cause of perioperative central nervous system (CNS) morbidity in such patients, it is also apparent that alterations in cerebral perfusion pressure and blood flow can profoundly influence the extent of injury after an embolic insult. In this context, the recent studies demonstrating improved CNS outcomes with applied neuromonitoring in cardiac surgical patients can be understood as reflecting the optimization of CNS perfusion characteristics with potential amelioration of microembolic injury. This review critically evaluates and discusses the relevant characteristics of applied neuromonitoring techniques, including bispectral index (BIS), transcranial Doppler (TCD), and near infrared reflectance spectroscopy (NIRS) in the context of patients undergoing cardiac surgical procedures. Recent outcomes data regarding CNS and related morbidity and the influence of neuromonitoring in these groups are evaluated.
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