A proposed algorithm for combining transcranial Doppler ultrasound monitoring with cerebral and somatic oximetry: a case
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A proposed algorithm for combining transcranial Doppler ultrasound monitoring with cerebral and somatic oximetry: a case report Proposition d’un algorithme combinant le monitorage e´chographique par Doppler transcraˆnien a` l’oxyme´trie ce´re´brale et somatique : une pre´sentation de cas Mile`ne A. Azzam, MD . Etienne J. Couture, MD . William Beaubien-Souligny, MD . Patrice Brassard, PhD . Caroline E. Gebhard, MD . Andre´ Y. Denault, MD, PhD Received: 26 May 2020 / Revised: 11 August 2020 / Accepted: 5 October 2020 Ó Canadian Anesthesiologists’ Society 2020
Abstract Purpose Transcranial Doppler (TCD) ultrasound is a non-invasive monitor of cerebral blood velocity that can be used intraoperatively. The purpose of this report is to describe how different patterns seen on TCD can help identify the cause of cerebral desaturation when nearinfrared spectroscopy (NIRS) oximetry is used concomitantly. Clinical features A 69-yr-old male patient undergoing coronary revascularisation and aortic valve replacement developed perioperative complications that were detected using a combination of transtemporal TCD of the middle cerebral artery along with cerebral and somatic NIRS. M. A. Azzam, MD Department of Anesthesiology, Montreal Heart Institute, Universite´ de Montre´al, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada E. J. Couture, MD Department of Anesthesiology and Critical Care Division, Quebec Heart and Lung Institute, Quebec, QC, Canada W. Beaubien-Souligny, MD Department of Anesthesiology, Montreal Heart Institute, Universite´ de Montre´al, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada
Initial brain desaturation was secondary to hypocapnia during which TCD-derived blood velocity and somatic NIRS values remained unchanged. After the procedure, a second episode of brain desaturation occurred secondary to a technical issue with the aortic valve prosthesis requiring a return to cardiopulmonary bypass (CPB); there were no high-intensity transient signals (HITS) on TCD. Brain desaturation occurred a third time following the second attempt to separate from CPB at which time TCD detected a significant amount of HITS suggesting air emboli that were associated with acute right ventricular dysfunction; there was also a reduction in somatic NIRS.
C. E. Gebhard, MD Department of Intensive Care Medicine, University Hospital of Basel, Basel, Switzerland A. Y. Denault, MD, PhD (&) Department of Anesthesiology, Montreal Heart Institute, Universite´ de Montre´al, 5000 Belanger Street, Montreal, QC H1T 1C8, Canada e-mail: [email protected] Critical Care Division, Montreal Heart Institute, Universite´ de Montre´al, Montreal, QC, Canada
Department of Nephrology, Centre Hospitalier de l’Universite´ de Montre´al, Montreal, QC, Canada P. Brassard, PhD Department of Kinesiology, Faculty of Medicine, Research Center, Institut universitaire de cardiologie et de pneumologie de Que´bec, Universite´ Laval, Quebec, QC, Canada
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Conclusions Combining TCD with cerebral NIRS allows
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