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Extended neuromonitoring in aortic arch surgery : A case series
Marcus Thudium1, Evgeniya Kornilov2,3, Tobias Hilbert2
1Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany. marcus.thudium@ukbonn.de.
Der Anaesthesist
|June 7, 2021
Summary
Multimodal neuromonitoring using processed electroencephalography (EEG), near-infrared spectroscopy (NIRS), and transcranial Doppler sonography (TCD) can guide hemodynamic management during aortic arch repair. This approach may improve patient outcomes in complex surgeries.
Area of Science:
- Neurosurgery
- Cardiovascular Surgery
- Medical Monitoring
Background:
- Aortic arch repair for aortic dissection has a high mortality rate.
- Cerebral hemodynamic guidance is crucial during selective anterior cerebral perfusion (SACP).
Purpose of the Study:
- To evaluate an easy multimodal neuromonitoring setup.
- Investigate the utility of processed EEG, NIRS, and TCD.
Main Methods:
- Collected intraoperative data from six patients undergoing aortic dissection surgery.
- Utilized bilateral NIRS, processed EEG (BIS), and intermittent TCD of the MCA.
- Measurements taken before, during cardiopulmonary bypass (CPB), and during SACP.
Main Results:
- Four patients survived without neurological deficits; two had fatal outcomes.
- Two survivors experienced transient postoperative delirium.
- Monitoring prompted changes in CPB flow or cannula repositioning in three patients; MCA flow velocities and BIS values decreased during SACP.
Conclusions:
- A multimodal monitoring system (BIS, NIRS, TCD) can influence hemodynamic management in aortic arch operations.
- This setup offers potential for improved patient safety and outcomes.
