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Peroperative Monitoring of Tissue Oximetry and Peroperative Use of Hypothermi a in Surgery on Cerebral Ane urysms


Authors: M. Smrčka 1;  K. Ďuriš 1;  V. Juráň 1;  E. Neuman 1;  M. Kýr 2
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno, 2Institut biostatistiky a analýz MU, Brno 1
Published in: Cesk Slov Neurol N 2009; 72/105(3): 245-249
Category: Original Paper

Overview

Introducti on:
During surgery on cerebral artery ane urysm, there is a risk of ischaemi a ca used by the use of temporary clips, brain tissue retracti on or mechanically driven vasospasms ca used by the manipulati on of brain vessels. Nowadays, tissue oxymetry is experimentally used for e arly detecti on of ischaemi a conditi oned by vasospasms. The aim of the rese arch is to evalu ate the possible use of brain tissue oximetry during surgery on cerebral artery ane urysm.

Materi al and methods:

We enrolled 25 pati ents who had been operated on for ane urysm. Pati ents were maintained in mild controlled hypothermi a during the operati on. The monitored parameters were brain tissue oxygen pressure (PbtO2), jugular bulb oxygen saturati on (SvjO2), me an arteri al pressure (MAP), and fracti on of inspired oxygen (FiO2).

Results:
In the study gro up, no correlati on exists either between peroperative values of PbtO2 and age, sex, Hunt Hess score, o utcome, localizati on or side of ane urysm or between peroperative values of PbtO2 and the SvjO2 or FiO2. A correlati on between PbtO2 and MAP (R = 0.44; p < 0.001) in the study gro up has been demonstrated. The incre asing durati on of the manipulati on of brain vessels poses a significant risk factor for a fall in PbtO2 values (p < 0.001). In all cases, the PbtO2 values decre ased after applying a temporary clip. In pati ents with peroperatively recorded peri ods of PbtO2 decre ase, the occurrence of ischemic changes on postoperative CT was comparable to the gro up in which no PbtO2 decre ase was peroperatively recorded.

Conclusi on:
We consider PbtO2 monitoring of surgery on cerebral artery ane urysms to be benefici al as it informs the surge on abo ut the length and depth of ischaemi a, thus drawing attenti on to the need for a change in the tactic of the surgery.

Key words:
oxymetry – hypothermia – aneurysm


Sources

1. Ohlstein EH, Storer BL. Oxyhemoglobin stimulati on of endothelin producti on in cultured endotheli al cells. J Ne urosurg 1992; 77(2): 274– 278.

2. Gelabert- González M, Fernández- Villa JM, Ginesta- Galan V. Intra- operative monitoring of brain tissue O2 (PtiO2) during ane urysm surgery. Acta Ne urochir 2002; 144(9): 863– 867.

3. Meixensberger J, Vath A, Jaeger M, Kunze E, Dings J, Ro osen K. Monitoring of brain tissue oxygenati on following severe subarachno id hemorrhage. Ne urol Res 2003; 25(5): 445– 450.

4. Stevens WJ. Multimodal monitoring: He ad injury management using SvjO2 and Licox. J Ne urosci Nurs 2004; 36(6): 332– 339.

5. Nortje J, Gupta AK. The role of tissue oxygen monitoring in pati ents with acute brain injury. Br J Anaesth 2006; 97(1): 95– 106.

6. Jaeger M, Soehle M, Meixensberger J. Brain tissue oxygen (PtiO2): a clinical comparison of two monitoring devices. Acta Ne urochir Suppl 2005; 95: 79– 81.

7. Hoelper BM, Alessandri B, Heimann A, Behr R, Kempski O. Brain oxygen monitoring: in‑vitro accuracy, long‑term drift and response- time of Licox and Ne urotrend sensors. Acta Ne urochir (Wi en) 2005; 147(7): 767– 774.

8. Sti efel MF, Spi otta A, Gracais VH, Garuffe AM, Guillamondegui O, Maloney- Wilensky E et al. Reduced mortality rate in pati ents with severe tra umatic brain injury tre ated with brain tisssue oxygen monitoring. J Ne urosurg 2005; 103(5): 805– 811.

9. Ki ening KL, Unterberg AW, Bardt TF, Schneider GH, Lanksh WR. Monitoring of cerebral oxygenati on in pati ents with severe he ad injuri es: brain tissue PO2 versus jugular vein oxygen saturati on. J Ne urosurg 1996; 85(5): 751– 757.

10. Meixensberger J, Ba unach S, Amschler J, Dings J, Ro osen K. Influence of body positi on on tissue PO2, cerebral perfusi on pressure and intracrani al pressure in pati ents with acute brain injury. Ne urol Res 1997; 19(3): 249– 253.

11. Kett- White R, Hutchinson PJ, Al- Rawi PG, Gupta AK, Pickard JD, Kirkaptrick PJ. Adverse cerebral events detected after subarachno id hemorrhage using brain oxygen and microdi alysis probes. Ne urosurgery 2002; 50(6): 1213– 1222.

12. Meixensberger J, Vath A, Jaeger M, Kunze E, Dings J, Ro osen K. Monitoring of brain tissue oxygenati on following severe subarachno id hemorrhage. Ne urol Res 2003; 25(5): 445– 450.

13. Kett- White R, Hutchinson PJ, Al- Rawi PG, Szosny ka M, Gupta AK, Pickard JD et al. Cerebral oxygen and microdi alysis monitoring during ane urysm surgery: effects of blo od pressure, cerebrospinal fluid drainage and temporary clipping on infarcti on. J Ne urosurg 2002; 96(6): 1013– 1019.

14. Lang EW, Mulvey JM, Mudali ar Y, Dorsch NW. Direct cerebral oxygenati on monitoring –  a systematic revi ew of recent publicati ons. Ne urosurg Rev 2007; 30(2): 99– 107.

15. Maas A, Fleckenstein W, de Jong D, van Santbrink H. Monitoring cerebral oxygenati on: experimental studi es and preliminary clinical results of continuo us monitoring of cerebrospinal fluid and brain tissue oxygen tensi on. Acta Ne urochir Suppl (Wi en) 1993; 59: 50– 57.

16. Littlejohns LR, Bader MK, March K. Brain tissue oxygen monitoring in severe brain injury. I. Rese arch and usefulness in critical care. Crit Care Nurse 2003; 23(4): 17– 25.

17. Meixensberger J, Dings J, Kuhnigk H, Rossen K. Studi es of tissue PO2 in normal and pathological human brain cortex. Acta Ne urochir Suppl (Wi en) 1993; 59: 58– 63.

18. Gál R, Smrčka M. Ne uroprotektivní po užití mírné hypotermi e během intrakrani ální chirurgi e mozkových ane uryzmat. Cesk Slov Ne urol N 2006; 69/ 102(5): 371– 375.

19. Lang EW, Czosnyka M, Mehdorn HM. Tissue oxygen re activity and cerebral a utoregulati on after severe tra umatic brain injury. Crit Care Med 2003; 31(1): 267– 271.

20. Critchley GR, O’Neill KS, Bell BA. Cerebral blo od flow and tissue oxygenati on monitoring during ane urysm surgery. Ne urol Res 1998; 20 (Suppl 1): 44– 47.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2009 Issue 3

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