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Intraoperative doppler transcranial

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https://www.readbyqxmd.com/read/29028933/novel-method-for-intraoperative-assessment-of-cerebral-autoregulation-by-paced-breathing
#1
N H Sperna Weiland, J Hermanides, M W Hollmann, B Preckel, W J Stok, J J van Lieshout, R V Immink, A R Absalom
Background: Cerebral autoregulation (CA) is the mechanism that maintains constancy of cerebral blood flow (CBF) despite variations in blood pressure (BP). Patients with attenuated CA have been shown to have an increased incidence of peri-operative stroke. Studies of CA in anaesthetized subjects are rare, because a simple and non-invasive method to quantify the integrity of CA is not available. In this study, we set out to improve non-invasive quantification of CA during surgery. For this purpose, we introduce a novel method to amplify spontaneous BP fluctuations during surgery by imposing mechanical positive pressure ventilation at three different frequencies and quantify CA from the resulting BP oscillations...
December 1, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28985690/influence-of-high-flow-modified-ultrafiltration-on-brain-oxygenation-and-perfusion-during-surgery-for-children-with-ventricular-septal-defects-a-pilot-study
#2
Zaishen Jia, Yichao Teng, Yuan Liu, Hong Wang, Yue Li, Xiaotong Hou
BACKGROUND: Modified ultrafiltration (MUF) can be performed in infants with ventricular septal defects (VSDs) after cardiopulmonary bypass (CPB) to reduce haemodilution and its potential adverse effects. High-flow MUF might reduce ultrafiltration duration and hasten the necessary correction of haemodilution during CPB. However, its influence on brain oxygenation remains controversial. OBJECTIVE: This non-randomized, prospective, pilot study aimed to investigate the influence of high-flow MUF on brain oxygenation in infants with VSDs...
October 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28891839/the-relative-effects-of-dexmedetomidine-and-propofol-on-cerebral-blood-flow-velocity-and-regional-brain-oxygenation-a-randomised-noninferiority-trial
#3
Ehab Farag, Michael Kot, Attila Podolyak, Maged Argalious, Milind Deogaonkar, Edward J Mascha, Zekun Xu, Irene Katzan, Zeyd Ebrahim
BACKGROUND: Dexmedetomidine constricts cerebral blood vessels without a concomitant reduction in cerebral metabolic oxygen consumption. Its safety as a sedative in patients with neurological diseases thus remains uncertain. OBJECTIVE: Our primary objective was to test the hypothesis that dexmedetomidine is noninferior to propofol as regards cerebral blood flow (CBF) velocity and brain oxygenation. DESIGN: Unblinded randomised trial. SETTING: Cleveland Clinic Hospital, Cleveland, from November 2010 to July 2013...
November 2017: European Journal of Anaesthesiology
https://www.readbyqxmd.com/read/28671861/the-transcranial-doppler-sonography-for-optimal-monitoring-and-optimization-of-cerebral-perfusion-in-aortic-arch-surgery-a-case-series
#4
Tamer Ghazy, Ayham Darwisch, Torsten Schmidt, Phong Nguyen, Sohaila Elmihy, Zuzana Fajfrova, Claudia Zickmüller, Klaus Matschke, Utz Kappert
OBJECTIVE: To analyze the feasibility and advantages of transcranial doppler sonography (TCD) for monitoring and optimization of selective cerebral perfusion (SCP) in aortic arch surgery. METHODS: From April 2013 to April 2014, nine patients with extensive aortic pathology underwent surgery under moderate hypothermic cardiac arrest with unilateral antegrade SCP under TCD monitoring in our institution. Adequate sonographic window and visualization of circle of Willis were to be confirmed...
June 16, 2017: Heart Surgery Forum
https://www.readbyqxmd.com/read/28648116/emboli-and-cognitive-state-in-surgical-vs-transcatheter-aortic-valve-replacement
#5
Tom Friedman, Oved Cohen, Avishai Ziser, Arthur Kerner, Keren Bitton-Worms, Gil Bolotin
Background Neurologic complications and neurocognitive impairment due to cerebral emboli are common following heart surgery. This study aimed to compare the number of emboli detected in the middle cerebral artery in open aortic valve replacement, apical and femoral transcatheter aortic valve replacement, and also to test for an association between the number of emboli captured in each procedure and changes in the patient's cognitive state. Methods Forty-four patients were enrolled in the study, 36 of whom were included in the final analyses: 14 underwent open aortic valve replacement, 2 had femoral transcatheter aortic valve replacement, and 10 had apical transcatheter aortic valve replacement...
January 1, 2017: Asian Cardiovascular & Thoracic Annals
https://www.readbyqxmd.com/read/28623598/cost-effectiveness-of-two-decision-strategies-for-shunt-use-during-carotid-endarterectomy
#6
Joe L P Kolkert, Rolf H H Groenwold, Vanessa J Leijdekkers, Joep Ter Haar, Clark J Zeebregts, Anco Vahl
BACKGROUND: Arterial shunting during carotid endarterectomy (CEA) is essential in some patients because of insufficient cerebral perfusion during cross-clamping. However, the optimal diagnostic modality identifying these patients is still debated. None of the currently used modalities has been proved superior to another. The aim of this study was to assess the cost-effectiveness of two modalities, stump pressure measurement (SPM) versus electroencephalography (EEG) combined with transcranial Doppler (TCD) during CEA...
November 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28281739/cerebral-micro-embolization-during-pulmonary-vein-isolation-relation-to-post-ablation-silent-cerebral-ischemia
#7
Edina Nagy-Baló, Mihran Martirosyan, Gábor Sándorfi, Orsolya Hajas, Levente Lánczi, Ervin Berényi, Lilla Ladányi, Alexandra Kiss, István Édes, Zoltán Csanádi
BACKGROUND: High incidences of silent cerebral ischemia (SCI) have been revealed by diffusion-weighted magnetic resonance imaging (DW MRI) after pulmonary vein isolation (PVI) for atrial fibrillation. A high number of mostly gaseous micro-embolic signals (MESs) was detected by transcranial Doppler (TCD) during PVI. In this investigation the possible relationship between MESs detected intraoperatively by TCD and new SCI on DW MRI post-ablation is reported. METHODS: 27 consecutive atrial fibrillation patients (6 female, age median: 64 interquartile range: 13...
March 10, 2017: Cardiology Journal
https://www.readbyqxmd.com/read/28223258/the-neurologic-protection-of-unilateral-versus-bilateral-antegrade-cerebral-perfusion-in-aortic-arch-surgery-with-deep-hypothermic-circulatory-arrest-a-study-of-77-cases
#8
COMPARATIVE STUDY
Bowen Li, Xiaoping Hu, Zhiwei Wang
BACKGROUD: Unilateral and bilateral antegrade cerebral perfusions (ACP) are recognized methods of cerebral protection in aortic arch surgery. However, the adequacy of cerebral protection in aortic arch surgery with deep hypothermic circulatory arrest is controversial. In this study, we compared unilateral and bilateral ACP of cerebral protection in aortic arch surgery by assessing the patient's intraoperative and postoperative brain function. METHODS: A total of 77 patients undergoing aortic arch surgery were included in this study...
April 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28203558/cerebral-monitoring-during-carotid-endarterectomy-by-transcranial-doppler-ultrasonography
#9
Woo-Sung Yun
PURPOSE: To evaluate the efficacy and safety of cerebral monitoring by transcranial Doppler ultrasonography (TCD) for the detection of cerebral ischemia during carotid endarterectomy (CEA). METHODS: From August 2004 to December 2013, 159 CEAs were performed in a tertiary hospital. All procedures were performed under general anesthesia. Intraoperative TCD was routinely used to detect cerebral ischemia. Of the 159 patients, 102 patients were included in this study, excluding 27 patients who had a poor transtemporal isonation window and 30 patients who used additional cerebral monitoring systems such as electroencephalography or somatosensory evoked potentials...
February 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28127789/transcranial-doppler-monitoring-in-carotid-endarterectomy-a-systematic-review-and-meta-analysis
#10
REVIEW
Reshmi Udesh, Piruthiviraj Natarajan, Karthy Thiagarajan, Lawrence R Wechsler, Donald J Crammond, Jeffrey R Balzer, Parthasarathy D Thirumala
OBJECTIVES: To evaluate the efficacy of intraoperative transcranial Doppler monitoring in predicting perioperative strokes after carotid endarterectomy (CEA). METHODS: An electronic search of PubMed, Embase, and Web of Science databases was conducted for studies on transcranial Doppler monitoring in CEA published from January 1970 through September 2015. All titles and abstracts were independently screened on the basis of predetermined inclusion criteria, which included randomized clinical trials and prospective or retrospective cohort reviews, patients who underwent CEA with intraoperative transcranial Doppler monitoring (either middle cerebral artery velocity [MCAV] or cerebral microembolic signals [MES]) and postoperative neurologic assessments up to 30 days after the surgery, and studies including an abstract, published in English on adult humans 18 years and older with a sample size of 50 or greater...
March 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/27566804/intraoperative-neuromonitoring-in-major-vascular-surgery
#11
V C So, C C M Poon
There has been a growing interest in using intraoperative neuromonitoring to reduce the incidence of stroke and paralysis in major vascular interventions. Electroencephalography, various neurophysiological evoked potential measurements, transcranial Doppler, and near-infrared spectroscopy are some of the modalities currently used to detect neural injuries. A good understanding of these modalities and their interactions with anaesthesia is important to maximize their value and to allow meaningful interpretation of their results...
September 2016: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/27283935/cerebral-microembolization-during-aortic-valve-replacement-using-minimally-invasive-or-conventional-extracorporeal-circulation-a-randomized-trial
#12
RANDOMIZED CONTROLLED TRIAL
Reto Basciani, Felix Kröninger, Erich Gygax, Hansjörg Jenni, David Reineke, Monika Stucki, Niels Hagenbuch, Thierry Carrel, Balthasar Eberle, Gabor Erdoes
To compare intraoperative cerebral microembolic load between minimally invasive extracorporeal circulation (MiECC) and conventional extracorporeal circulation (CECC) during isolated surgical aortic valve replacement (SAVR), we conducted a randomized trial in patients undergoing primary elective SAVR at a tertiary referral hospital. The primary outcome was the procedural phase-related rate of high-intensity transient signals (HITS) on transcranial Doppler ultrasound. HITS rate was used as a surrogate of cerebral microembolism in pre-defined procedural phases in SAVR using MiECC or CECC with (+F) or without (-F) an oxygenator with integrated arterial filter...
December 2016: Artificial Organs
https://www.readbyqxmd.com/read/26902940/feasibility-and-safety-of-simultaneous-carotid-endarterectomy-and-carotid-stenting-for-bilateral-carotid-stenosis-a-single-center-experience-using-a-hybrid-procedure
#13
Rong-Wei Xu, Peng Liu, Xue-Qiang Fan, Qian Wang, Jian-Bin Zhang, Zhi-Dong Ye
BACKGROUND: The treatment for bilateral carotid stenosis (BCS) is challenging, and the optimal treatment strategy is not clear. We report our experience of treating 8 patients with BCS by simultaneous carotid endarterectomy (CEA) and carotid stenting (CAS), thereby providing an alternative for vascular surgeons. METHODS: Between October 2010 and August 2014, 8 patients (5 males and 3 females; range, 53-82 years; mean, 69 ± 8.8 years) underwent simultaneous CEA and CAS in our hospital...
May 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/26898919/digital-carotid-compression-a-simple-method-to-reduce-solid-cerebral-emboli-during-cardiac-surgery
#14
RANDOMIZED CONTROLLED TRIAL
Julia Hillebrand, Amin Rouhollahpour, Andreas Zierer, Anton Moritz, Sven Martens
OBJECTIVES: Serious neurologic injury can be attributed to embolization of solid particles into cerebral vessels during cardiac surgery. Previous studies using transcranial Doppler (TCD) identified arterial cannulation and aortic declamping to be associated with cerebral embolization. The purpose of this study was to investigate the impact of transient compression of the carotid arteries during these maneuvers on the embolic load during cardiac surgery with cardiopulmonary bypass. DESIGN: Prospective, randomized, clinical trial/pilot study...
April 2016: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/26889442/selective-carotid-shunting-based-on-intraoperative-transcranial-doppler-imaging-during-carotid-endarterectomy-a-retrospective-single-center-review
#15
Jun Woo Cho, Yun-Ho Jeon, Chi Hoon Bae
BACKGROUND: Carotid endarterectomy (CEA) with selective shunting is the surgical method currently used to treat patients with carotid artery disease. We evaluated the incidence of major postoperative complications in patients who underwent CEA with selective shunting under transcranial Doppler (TCD) at our institution. METHODS: The records of 45 patients who underwent CEA with TCD-based selective shunting under general anesthesia from November 2009 to June 2015 were reviewed...
February 2016: Korean Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/26879693/the-effect-of-blood-pressure-and-cardiac-output-on-the-quality-of-the-surgical-field-and-middle-cerebral-artery-blood-flow-during-endoscopic-sinus-surgery
#16
RANDOMIZED CONTROLLED TRIAL
Thanh Ngoc Ha, Robert Graham van Renen, Guy L Ludbrook, Peter-John Wormald
BACKGROUND: A clear surgical field is critical during endoscopic sinus surgery (ESS). Hypotensive anesthesia and cardiac output (CO) may optimize the surgical field; however, evidence of their effect on bleeding and cerebral blood flow is conflicting. The aim of this study was to evaluate the effect of blood pressure (BP) and CO on intraoperative bleeding and middle cerebral artery blood flow velocity (Vmca ) during ESS. METHODS: This was a prospective randomized controlled trial...
July 2016: International Forum of Allergy & Rhinology
https://www.readbyqxmd.com/read/26794908/transcervical-carotid-stenting-with-dynamic-flow-reversal-demonstrates-embolization-rates-comparable-to-carotid-endarterectomy
#17
COMPARATIVE STUDY
Maarten Plessers, Isabelle Van Herzeele, Dimitri Hemelsoet, Nikil Patel, Emma M L Chung, Guy Vingerhoets, Frank Vermassen
PURPOSE: To evaluate a series of patients treated electively with carotid endarterectomy (CEA), transfemoral carotid artery stenting with distal filter protection (CASdp), and transcervical carotid stenting with dynamic flow reversal (CASfr) monitored continuously with transcranial Doppler (TCD) during the procedure to detect intraoperative embolization rates. METHODS: Thirty-four patients (mean age 67.6 years; 24 men) with significant carotid stenosis underwent successful TCD monitoring during the revascularization procedure (10 CEA, 8 CASdp, and 16 CASfr)...
April 2016: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/26783262/intraoperative-embolization-and-cognitive-decline-after-cardiac-surgery-a-systematic-review
#18
REVIEW
Nikil Patel, Jatinder S Minhas, Emma M L Chung
Since the advent of cardiac surgery, complications have existed in many forms. Recent work has focused on the safety of current cardiac surgery with particular emphasis on cognitive outcomes. Cardiopulmonary bypass has improved the safety of operative practice; however, increasing concern surrounds the measurable and immeasurable impact embolization has on the brain. New ischemic lesions have been associated with distant emboli, which intraoperatively enter the cardiovascular system. This has prompted better characterization of the nature of emboli manifesting as cognitive impairment postoperatively...
September 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/26771727/transcranial-doppler-and-diffusion-weighted-magnetic-resonance-evaluation-of-cerebral-embolization-occurring-during-transfemoral-carotid-stenting-with-proximal-flow-blockage
#19
Giovanni Palombo, Nazzareno Stella, Cristiano Fantozzi, Alessandro Bozzao, Maurizio Taurino
BACKGROUND: Transfemoral carotid artery stenting (CAS) with endovascular proximal flow blockage is deemed able to reduce the cerebral embolization observed during filter-protected CAS. We evaluated clinical outcome and intraoperative embolization rates, measured by diffusion-weighted magnetic resonance imaging (DW-MRI) and transcranial Doppler monitoring, in a series of patients undergoing CAS with proximal flow blockage. METHODS: A series of 35 consecutive patients with symptomatic or asymptomatic internal carotid artery stenosis ≥70% were included to undergo CAS with proximal flow blockage, obtained with the Mo...
February 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/26723102/outer-ear-canal-sound-pressure-and-bone-vibration-measurement-in-ssd-and-chl-patients-using-a-transcutaneous-bone-conduction-instrument
#20
Mohammad Ghoncheh, Giorgio Lilli, Thomas Lenarz, Hannes Maier
The intraoperative and postoperative objective functional assessment of transcutaneous bone conduction implants is still a challenge. Here we compared intraoperative Laser-Doppler-vibrometry (LDV, Polytec Inc.) to measure vibration of the bone close to the implant to Outer Ear Canal Sound Pressure Level (OEC-SPL) measurements. Twelve single sided deafness (SSD) patients with contralateral intact ossicular chains and eight bilateral conductive hearing loss (CHL) patients were included in the study. SSD patients had a minor average air-bone-gap (ABG) of 0...
October 2016: Hearing Research
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