Near-Infrared Spectroscopy-Guided, Individualized Arterial Blood Pressure Management for Carotid Endarterectomy under...

Area of Science:

• Neurosurgery
• Anesthesiology
• Cardiovascular Medicine

Background:

• Blood pressure variations impact brain ischemia risk, surgical complications, and neurocognitive outcomes in carotid endarterectomy (CEA) patients.
• Maintaining optimal blood pressure is crucial during CEA to prevent adverse events.

Purpose of the Study:

• To evaluate the efficacy of near-infrared spectroscopy (NIRS)-guided blood pressure management versus standard care during CEA.
• To assess the impact of NIRS guidance on postoperative neurocognitive function and perioperative complications.

Main Methods:

• A single-center trial randomized CEA patients under general anesthesia into NIRS-guided or standard care groups.
• Near-infrared spectroscopy (NIRS) guided blood pressure management during carotid cross-clamping in the intervention group.
• Postoperative neurocognitive function was the primary endpoint, with perioperative complications and cerebral autoregulation as secondary endpoints.

Main Results:

• No significant difference in postoperative neurocognitive function was observed between the NIRS-guided and standard care groups.
• The NIRS-guided group exhibited significantly lower systolic blood pressure and norepinephrine doses during carotid cross-clamping.
• The rate of perioperative complications was substantially lower in the NIRS-guided group (3.3% vs. 26.7%).

Conclusions:

• NIRS-guided blood pressure management in CEA patients undergoing general anesthesia did not alter postoperative neurocognitive function compared to standard care.
• Individualized blood pressure management using NIRS led to reduced vasopressor administration and fewer perioperative complications.