Monitoring of antegrade selective cerebral perfusion for aortic arch surgery with transcranial Doppler ultrasonography and near-infrared spectroscopy
10.3760/j.issn:0366-6999.2001.03.007
- VernacularTitle:主动脉外科选择性顺行脑灌注的经颅多谱勒和脑氧饱和度监测
- Author:
Qinjun YU
1
;
Lizhong SUN
;
Qian CHANG
;
Guimin SUN
;
Jin LIU
Author Information
1. Departments of Anesthesiology
- Keywords:
transcranial Doppler ultrasonography near-infrared spectroscopy antegrade selective cerebral perfusion aortic surgery
- From:
Chinese Medical Journal
2001;114(3):257-261
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses. Methods In twenty-two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD). During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery. The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO2) using dual-wavelength spatially resolved near-infrared spectroscopy. Results All patients experienced an uneventful recovery. Flow in the middle cerebral artery became undetectable at ASCP < 5*!ml*kg-1*min-1, so adjustments from a 15-20*!ml*kg-1*min-1 baseline were used to maintain rSO2 above 50%. Furthermore, ASCP flow was highly correlated (P<0.01) with both peak middle cerebral artery velocity and rSO2 (r=0.86 and 0.96, respectively). Conclusion Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort.
