Neurologic monitoring on cardiopulmonary bypass: what are we obligated to do? Ann Thorac Surg 2006 Jun;81(6):S2373-80
Date
05/30/2006Pubmed ID
16731106DOI
10.1016/j.athoracsur.2006.02.076Scopus ID
2-s2.0-33646849248 (requires institutional sign-in at Scopus site) 70 CitationsAbstract
Improving survival from congenital cardiac repairs using cardiopulmonary bypass has appropriately shifted focus to neurologic outcomes. Hypoxic-ischemic mechanisms are the major cause of neurologic injury in neonatal cardiac surgery, and modifications of techniques of cardiopulmonary bypass can affect organ oxygen delivery and the propensity to injury both during and after surgery. Through successive refinements in the techniques of cardiopulmonary bypass, the risk factors for hypoxic-ischemic injury have been reduced, but not eliminated. The application of specific monitoring to enhance detection of hypoxic conditions associated with neurologic injury would both allow intervention on individual patients and drive refinements in strategies to further reduce risk. Specific neurologic monitoring techniques that can be used during cardiopulmonary bypass include near-infrared spectroscopy, transcranial Doppler ultrasonography, and electroencephalographic techniques. Of these, only near-infrared spectroscopy provides a continuous quantitative signal of the physiologic variable most related to injury and most amenable to intervention. This review will advocate wide adoption of near-infrared spectroscopy monitoring throughout the perioperative period, to enhance detection of hypoxic conditions and to drive patient-specific interventions.
Author List
Hoffman GMAuthor
George M. Hoffman MD Chief, Professor in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Brain Damage, ChronicCardiopulmonary Bypass
Electroencephalography
Extracorporeal Membrane Oxygenation
Hemoglobinometry
Humans
Hypoxia
Hypoxia-Ischemia, Brain
Infant
Infant, Newborn
Intracranial Embolism
Intraoperative Complications
Magnetic Resonance Imaging
Monitoring, Intraoperative
Oxyhemoglobins
Postoperative Complications
Risk Factors
Spectroscopy, Near-Infrared
Ultrasonography, Doppler, Transcranial
