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 |