Cerebral oximetry in cardiovascular dialysis patients
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Hellenic Journal of Surgery (2013) 85:1, 328-332
Cerebral oximetry in cardiovascular dialysis patients G. Papadopoulos, V. Tatsis, G. Papathanakos, M. Korre, C. Gouva, K. Katopodis, P. Tzimas, G. Glantzounis, M. Mitsis
Abstract Background Clinical studies suggest that cerebral oxygenation is low in patients on dialysis. Ī”eport of two cases The authors describe the cases of two cardiovascular dialysis patients with chronic kidney dis-
ease who underwent coronary artery revascularization and intravascular repair of an abdominal aortic aneurysm. These patients had baseline values of cerebral oximetry below normal (within the range of 36-42%) as estimated by near-infrared spectroscopy (NIRS). This was accompanied by cognitive dysfunction according to the Mini Mental State Examination Score. Results Cerebral oximetry values were stabilized during surgery after administration of crystalloid fluids and vaso-
constrictive drugs and they ameliorated significantly after administration of one unit of blood. Conclution These observations underline the importance of the evaluation of cerebral tissue oxygenation by non-
invasive cerebral NIRS in chronic kidney disease, both intraoperatively and generally. Key words Cerebral oximetry, chronic kidney disease, cardiovascular patients
Background Cerebral oximetry, through the near-infrared spectroscopy (NIRS) technique, is a new, non-invasive monitoring method of cerebral oxygenation. It measures venous saturation in the brain (rSO2), reflecting the balance between oxygen demand and supply. [1] In published studies, normal cerebral oximetry values for rSO2 are considered to range between 55%-78%. [2-4] Cerebral oximetry values are influenced by age, [5] arterial haemoglobin oxygen saturation and carbon dioxide partial pressure, [6] haemoglobin concentration, [7] cardiac index [8] and blood volume. [9] In addition, the performance (structure and function) of the arterial bed [10,11] critically involves the blood-oxygen supply of the brain, [12] which in turn influences the rSO2. Clinical studies suggest that trans-cranial cerebral tissue oximetry is a useful tool for monitoring patients during G. Papadopoulos, G. Papathanakos, M. Korre, P. Tzimas Anaesthesiology Department and Postoperative Intensive Care Unit, Medical School, University Hospital of Ioannina V. Tatsis, G. Glantzounis, M. Mitsis Department of Surgery, Medical School, University Hospital of Ioannina C. Gouva, K. Katopodis Department of Nephrology, General Hospital of Arta Corresponding Author: Tatsis Vasileios, MD Department of Surgery, University Hospital of Ioannina Stavros Niarchos Avenue, 45500 Ioannina, Greece e-mail: [email protected] Received 21 Feb 2013; Accepted 26 April 2013
Hellenic Journal of Surgery 85
cardiac, vascular, orthopaedic and general abdominal surgery. [8,9,13,14] Patients of particular interest are dialysis patients with chronic kidney disease. Besides the factors already mentioned, arteriosclerosis (which due to vascular calcifications has already begun in the early stages o
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