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Published on: June 3, 2021
Review of transcranial Doppler ultrasound to detect microemboli during orthopedic surgery
B S Silbert1, L A Evered2, D A Scott2
1From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia Department of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School brendan.silbert@svhm.org.au.
Abstract:
Transcranial Doppler ultrasonography has been used to detect microemboli in the middle cerebral artery during orthopedic surgery. We conducted a comprehensive systematic literature review of transcranial Doppler ultrasonography in orthopedic surgery to evaluate its status in this setting. Fourteen studies were selected for qualitative analysis. The highest number of patients studied was 45; emboli were detected in all studies, occurring in 20%-100% of patients. Most embolic counts were below 10, but some high counts were noted. No study reported all the technical parameters of the transcranial Doppler ultrasonography. All studies assessed neurologic status, and 6 studies evaluated cognitive function postoperatively. No study identified an association between postoperative cognitive function and embolic count. Six studies sought the presence of right-to-left shunts.
Insights
Transcranial Doppler ultrasonography detected microemboli in orthopedic surgery patients in all reviewed studies. However, no study linked these emboli to postoperative cognitive function, highlighting a gap in current research.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Imaging
Background:
- Transcranial Doppler (TCD) ultrasonography is utilized to detect microemboli in the middle cerebral artery during orthopedic procedures.
- Microembolic signals (MES) during surgery may pose risks to neurological function.
- The clinical significance of MES in orthopedic surgery requires further investigation.
Purpose of the Study:
- To conduct a systematic literature review of transcranial Doppler ultrasonography in orthopedic surgery.
- To evaluate the current status and findings of TCD use for microemboli detection in this surgical setting.
Main Methods:
- A comprehensive systematic literature review was performed.
- Fourteen studies involving transcranial Doppler ultrasonography during orthopedic surgery were selected for qualitative analysis.
- Studies were analyzed for patient numbers, emboli detection rates, embolic counts, reported technical parameters, neurological status assessment, cognitive function evaluation, and assessment of right-to-left shunts.
Main Results:
- Microemboli were detected in 20%-100% of patients across all 14 studies.
- While most embolic counts were low, some studies reported high counts.
- No study reported complete technical parameters for transcranial Doppler ultrasonography.
- All studies assessed neurological status, and six evaluated postoperative cognitive function, but no association with embolic count was found.
- Six studies investigated the presence of right-to-left shunts.
Conclusions:
- Transcranial Doppler ultrasonography consistently detects microemboli during orthopedic surgery.
- There is a lack of evidence linking intraoperative microemboli detected by TCD to postoperative cognitive dysfunction in orthopedic patients.
- Further research is needed to standardize TCD technical parameters and clarify the clinical implications of microemboli in this context.
