Extended neuromonitoring in aortic arch surgery A case series

• Published in: Der Anaesthesist Vol. 70; no. Suppl 1; pp. 68 - 73
• Main Authors: Thudium, Marcus, Kornilov, Evgeniya, Hilbert, Tobias, Coburn, Mark, Gestrich, Christopher
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Medizin 01-12-2021
• Subjects: Anesthesiology; Aneurysm, Dissecting - diagnostic imaging; Aneurysm, Dissecting - surgery; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Cardiopulmonary Bypass; Cerebrovascular Circulation; Critical Care Medicine; Emergency Medicine; Humans; Intensive; Kasuistiken; Medicine; Medicine & Public Health; Monitoring, Intraoperative; Pain Medicine; Ultrasonography, Doppler, Transcranial; Transcranial doppler; Transkranieller Doppler; Cerebral perfusion; EEG; NIRS; Aortic dissection; Aortendissektion; Hirnperfusion
• ISSN: 0003-2417; 1432-055X
• DOI: 10.1007/s00101-021-00983-y

Background
Aortic arch repair for aortic dissection is still associated with a high mortality rate. Providing adequate means of neuromonitoring to guide cerebral hemodynamics is advantageous, especially during selective anterior cerebral perfusion (SACP).
Objective
We aimed to investigate an easy multimodal neuromonitoring set-up consisting of processed electroencephalography (EEG), near infrared spectroscopy (NIRS), and transcranial doppler sonography (TCD).
Material and methods
We collected intraoperative data from six patients undergoing surgery for aortic dissection. In addition to standard hemodynamic monitoring, patients underwent continuous bilateral NIRS, processed EEG with bispectral index (BIS), and intermittent transcranial doppler sonography of the medial cerebral artery (MCA) with a standard B‑mode ultrasound device. Doppler measurements were taken bilaterally before cardiopulmonary bypass (CPB), during CPB, and during SACP at regular intervals.
Results
Of the patients four survived without neurological deficits while two suffered fatal outcomes. Of the survivors two suffered from transient postoperative delirium. Multimodal monitoring led to a change in CPB flow or cannula repositioning in three patients. Left-sided mean flow velocities of the MCA decreased during SACP, as did BIS values.
Conclusion
Monitoring consisting of BIS, NIRS, and TCD may have an impact on hemodynamic management in aortic arch operations.