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Neurophysiological Intraoperative Monitoring During Aortic Arch Surgery.

Publication ,  Journal Article
Keenan, JE; Benrashid, E; Kale, E; Nicoara, A; Husain, AM; Hughes, GC
Published in: Semin Cardiothorac Vasc Anesth
December 2016

Circulatory management during replacement of the aortic arch is complex and involves a period of circulatory arrest to provide a bloodless field during arch vessel anastomosis. To guard against ischemic brain injury, tissue metabolic demand is reduced by systemically cooling the patient prior to circulatory arrest. Neurophysiological intraoperative monitoring (NIOM) is often used during the course of these procedures to provide contemporaneous assessment of brain status to help direct circulatory management decisions and detect brain ischemia. In this review, we discuss the characteristics of electrocerebral activity through the process of cooling, circulatory arrest, and rewarming as depicted through commonly used NIOM modalities, including electroencephalography and peripheral nerve somatosensory-evoked potentials. Attention is directed toward the role NIOM has traditionally played during deep hypothermic circulatory arrest, where it is used to define the point of electrocerebral inactivity or maximal cerebral metabolic suppression prior to initiating circulatory arrest while also discussing the evolving utility of NIOM when systemic circulatory arrest is initiated at more moderate degrees of hypothermia in conjunction with regional brain perfusion. The use of cerebral tissue oximetry by near-infrared spectroscopy as an alternative NIOM modality during surgery of the aortic arch is addressed as well. Finally, special considerations for NIOM and the detection of spinal cord ischemia during hybrid aortic arch repair and emerging operative techniques are also discussed.

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Published In

Semin Cardiothorac Vasc Anesth

DOI

EISSN

1940-5596

Publication Date

December 2016

Volume

20

Issue

4

Start / End Page

273 / 282

Location

United States

Related Subject Headings

  • Spectroscopy, Near-Infrared
  • Monitoring, Intraoperative
  • Humans
  • Evoked Potentials, Somatosensory
  • Endovascular Procedures
  • Electroencephalography
  • Circulatory Arrest, Deep Hypothermia Induced
  • Aorta, Thoracic
  • Anesthesiology
 

Citation

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MLA
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Keenan, J. E., Benrashid, E., Kale, E., Nicoara, A., Husain, A. M., & Hughes, G. C. (2016). Neurophysiological Intraoperative Monitoring During Aortic Arch Surgery. Semin Cardiothorac Vasc Anesth, 20(4), 273–282. https://doi.org/10.1177/1089253216672441
Keenan, Jeffrey E., Ehsan Benrashid, Emily Kale, Alina Nicoara, Aatif M. Husain, and G Chad Hughes. “Neurophysiological Intraoperative Monitoring During Aortic Arch Surgery.Semin Cardiothorac Vasc Anesth 20, no. 4 (December 2016): 273–82. https://doi.org/10.1177/1089253216672441.
Keenan JE, Benrashid E, Kale E, Nicoara A, Husain AM, Hughes GC. Neurophysiological Intraoperative Monitoring During Aortic Arch Surgery. Semin Cardiothorac Vasc Anesth. 2016 Dec;20(4):273–82.
Keenan, Jeffrey E., et al. “Neurophysiological Intraoperative Monitoring During Aortic Arch Surgery.Semin Cardiothorac Vasc Anesth, vol. 20, no. 4, Dec. 2016, pp. 273–82. Pubmed, doi:10.1177/1089253216672441.
Keenan JE, Benrashid E, Kale E, Nicoara A, Husain AM, Hughes GC. Neurophysiological Intraoperative Monitoring During Aortic Arch Surgery. Semin Cardiothorac Vasc Anesth. 2016 Dec;20(4):273–282.
Journal cover image

Published In

Semin Cardiothorac Vasc Anesth

DOI

EISSN

1940-5596

Publication Date

December 2016

Volume

20

Issue

4

Start / End Page

273 / 282

Location

United States

Related Subject Headings

  • Spectroscopy, Near-Infrared
  • Monitoring, Intraoperative
  • Humans
  • Evoked Potentials, Somatosensory
  • Endovascular Procedures
  • Electroencephalography
  • Circulatory Arrest, Deep Hypothermia Induced
  • Aorta, Thoracic
  • Anesthesiology