Laser speckle contrast imaging of forehead cutaneous blood flow during carotid endarterectomy as a potential non-invasiv
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ORIGINAL RESEARCH
Laser speckle contrast imaging of forehead cutaneous blood flow during carotid endarterectomy as a potential non-invasive method for surrogate monitoring of cerebral perfusion Mads J. Niemann1 · Jonas P. Eiberg2,3,4 · Henrik Sørensen1,5 · Niels H. Secher1,4 Received: 27 May 2020 / Accepted: 8 September 2020 © Springer Nature B.V. 2020
Abstract Monitoring cerebral perfusion is important for goal-directed anesthesia. Taking advantage of the supply of the supraorbital region and Glabella from the internal carotid artery (ICA), we evaluated changes in cutaneous blood flow using laser speckle contrast imagining (LSCI) as a potential method for indirect real-time monitoring of cerebral perfusion. Nine patients (8 men, mean age 70 years) underwent eversion carotid endarterectomy under local anesthesia. Cutaneous blood flow of the forehead was monitored using LSCI. During clamping of the common carotid artery (CCA), ipsilateral supraorbital region and Glabellas cutaneous blood flow dropped from 334 ± 135 to 221 ± 109 AU (p = 0.023) (AU: arbitrary flux units) and from 384 ± 151 to 276 ± 107 AU (p = 0.023), respectively, whilst the contralateral supraorbital region cutaneous blood flow remained unchanged. The supraorbital cutaneous blood flow did not change significantly following reperfusion of the external carotid artery (ECA) (221 ± 109 to 281 ± 154 AU; p = 0.175) and ICA (281 ± 154 to 310 ± 184 AU; p = 01). A comparable trend for Glabella followed ECA (276 ± 107 to 342 ± 170 AU; p = 0.404) and ICA (342 ± 170 to 352 ± 191 AU; p = 01) reperfusion. In patients undergoing carotid endarterectomy under local anesthesia, LSCI of the supraorbital and Glabella regions reflected clamping of the CCA but did not distinguish reperfusion of the ICA from that of the ECA. Keywords Carotid endarterectomy · Forehead · Glabella · Laser speckle contrast imagining · Microcirculation · Cerebral perfusion Abbreviations AU Arbitrary flux unit CCA Common carotid artery CEA Carotid endarterectomy ECA External carotid artery EEG Electroencephalography GA General anesthesia ICA Internal carotid artery * Mads J. Niemann [email protected] 1
Department of Anesthesiology 2043, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
2
Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
3
Copenhagen Academy for Medical Education and Simulation (CAMES), Copenhagen, Denmark
4
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
5
Department of Integrative Physiology, NEXS, University of Copenhagen, Copenhagen, Denmark
LSCI Laser speckle contrast imagining LRA Local regional anesthesia NIRS Near infra-red spectroscopy ROI Regions of interest SD Standard deviation TCD Transcranial Doppler
1 Introduction Maintaining adequate cerebral perfusion and avoiding cerebral hypoxia are important goals during surgery underlining the need for reliable and real-time monitoring. Systemic blood pressure above the accepted lower limit of the cerebral autoregulati
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