Neuromonitoring

Prolonged tissue desaturations are common, harmful, and preventable. This learning module will explore the
application of tissue oximetry to identify desaturations early and help ensure your patient is adequately perfused.

Decreased cerebral blood flow during cardiac surgery can result in various adverse outcomes, including neurological complications, cognitive impairment, an increased risk of stroke, prolonged hospitalization, and, in extreme cases, mortality. It underscores the importance of careful monitoring and management of cerebral perfusion during these high-risk procedures to improve patient outcomes and reduce the likelihood of serious complications.

The brain relies on a consistent supply of oxygen and nutrients carried by blood, and any interruption in this supply can lead to adverse effects:

Delirium:

• Reduced cerebral blood flow can result in a higher risk of post-operative delirium. This can result in impaired recovery, prolonged stay, or long-term diminished cognitive function.

Cognitive Impairment:

• Patients may experience temporary or even permanent cognitive impairment due to insufficient oxygenation of brain tissue during surgery. This can affect memory, concentration, and overall cognitive function.

Increased Risk of Stroke:

• Decreased blood flow to the brain increases the risk of ischemic strokes, which can result in physical disabilities and further complications.

Prolonged Hospital Stay:

• Patients who experience cerebral hypoperfusion during cardiac surgery may require longer hospital stays for recovery and rehabilitation, adding to the overall healthcare costs and potentially reducing the patient's quality of life.

Postoperative Rehabilitation:

• Patients who suffer from neurological complications due to decreased cerebral blood flow may require extensive postoperative rehabilitation to regain lost function, which can be physically and emotionally challenging.

Neurologic monitoring during cardiac surgery has demonstrated several benefits in improving patient outcomes. Here's a summary of the evidence supporting the use of neurologic monitoring in this context:

Early Detection of Complications:

• Allows for the early detection of changes in cerebral blood flow and electrical activity. This enables prompt intervention when complications arise, potentially preventing severe brain injury.

Reduced Risk of Stroke:

• Continuous monitoring can help identify and mitigate factors that increase the risk of perioperative stroke, such as hypoperfusion. By promptly addressing these issues, the risk of stroke can be reduced.

Tailored Anesthesia Management:

• EEG monitoring provides real-time information about the patient's brain activity under anesthesia. Anesthesiologists can use this data to adjust the depth of anesthesia, minimizing both the risk of awareness and neurologic injury from excessive anesthetic depth during surgery.

Optimization of Cerebral Perfusion:

• Monitoring cerebral blood flow allows surgical teams to maintain optimal perfusion pressure and avoid extremes in blood pressure that could compromise brain function. This helps reduce the risk of ischemic injury during surgery.

Customized Surgical Approach:

Neurologic monitoring can help guide surgical decision-making. For example, adequate perfusion can be assessed when various neurocirculatory techniques such as selective antegrade perfusion are applied for aortic surgery.

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This summary was written with assistance from artificial intelligence. All text was reviewed, edited, and supplemented by the listed editor(s). Reference: OpenAI. (2023). ChatGPT (Sept 25 version) [Large language model]. https://chat.openai.com/chat

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