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Table 2 Clinical application of neuromonitoring in the operating room

From: The Importance of Neuromonitoring in Non Brain Injured Patients

Type of surgery/ procedure

Neurological complications

Neuromonitoring

Evidence

Major vascular surgery

Stroke, delirium, cognitive decline, paralysis

EEG or pEEG

Beta bands, slow background, reduction of amplitude on EEG, reduction of BIS on pEEG are signs of ischemia (carotid surgery)

Evoked potentials

Abnormalities in the SSEPs of median and tibial nerves if hypoperfusion (carotid surgery). MEPs correlate with NIRS

TCD

TCD can allow detection of stenosis, turbulence, and emboli (carotid surgery)

NIRS

Cerebral rSO2 < 70% is indicative of possible hypoperfusion (carotid surgery), lumbar rSO2 < 75% for 15 min can cause spinal cord injury (aortic repair)

Cardiac surgery

Delirium, cognitive dysfunction, stroke

EEG or pEGG

Long-term EEG burst suppression is associated with cognitive dysfunction and delirium. Decrease in alpha and beta waves is indicative of tissue hypoperfusion

Evoked potentials

Help in the detection of ischemia, not specific

TCD

TCD can detect changes in CBF, microemboli, flow asymmetries

NIRS

An rSO2 value which falls by 10–20% or < 50% is associated with postoperative complications. The threshold of rSO2 > 80% prevents complications

Abdominal surgery

Neurological deterioration, intracranial hypertension

TCD

TCD can allow non-invasive calculation of ICP, identification of changes in CBF due to high ICP or carbon-dioxide vasodilatation

Orthopedic surgery

Cerebral deoxygenation

NIRS

Cerebral rSO2 monitoring can prevent cerebral deoxygenation and neurological complications

  1. EEG electroencephalogram, pEEG processed EEG, TCD transcranial Doppler; NIRS near infrared spectroscopy, BIS Bispectral index, rSO2 regional saturation of oxygen, MEPs motor evoked potentials, SSEPs sensory evoked potentials, CBF cerebral blood flow, ICP intracranial pressure