Intraoperative Monitoring of Scalp-recorded SEPs During Carotid Endarterectomy

1988 ◽  
pp. 107-119 ◽  
Author(s):  
M. Caramia ◽  
F. Zarola ◽  
G. L. Gigli ◽  
F. Lavaroni ◽  
P. M. Rossini



Author(s):  
R Kesarwani ◽  
M Findlay

Background: Cross-clamp ischemia during carotid endarterectomy (CEA) can cause perioperative stroke. Selectively shunting patients based on intraoperative monitoring modalities that assess risk for ischemia can reduce the occurrence of immediate stroke. An experience with combined cerebral oximetry and stump pressure measurement to direct selective shunting is presented here. Methods: Study comparing intraoperative monitoring data, the decision to shunt, and presence of immediate post-operative deficits. Patients were shunted if either cerebral oxygen saturation dropped by more than 10% by cerebral oximetry, or stump pressure during cross-clamping was less than 40 mmHg. Cross-clamp ischemia was determined by the presence of ipsilateral neurological deficit upon awakening. Results: 245 patients were included in this study. 22% were shunted. Patients who were not shunted were significantly more likely to have collateral blood flow detected on angiography. Immediate post-operative stroke was not encountered in any of the patients included in the study. One patient who met shunting criteria but was excluded since he could not have a shunt inserted due to difficult anatomy did suffer stroke. Conclusions: With the dual-monitoring criteria presented here, 22% of patients were shunted. With the exception of one patient who could not have a shunt placed, no immediate post-operative stroke was encountered.





2021 ◽  
Vol 10 (1) ◽  
pp. 22-28
Author(s):  
Chrismas Gideon Bangun ◽  
◽  
RR Sinta Irina ◽  
Dewi Yulianti Bisri ◽  
Eri Surachman ◽  
...  

Carotid endarterectomy (CEA) is a surgical procedure performed to restore carotid blood flow and reduce the incidence of embolic and thrombotic strokes. Although it is a preventive procedure, CEA carries the risk of perioperative complications: neurologic and cardiac. Major complications of CEA are intra and postoperative stroke, myocardial infarction, and death. To reduce the number of intraoperative stroke events, one of them is to develop intraoperative monitoring technology with electroencephalogram (EEG). In this case, a male patient, 62 years old, with statistics of recurrent stroke and left leg weakness was approved for CEA under general anesthesia. Surgeons decide to use shunt selectively by assessing EEG monitoring when clamping. Finally the shunt was not performed, the operation lasted for 6 hours, tinged with hemodynamic shocks that often occur in patients with carotid disease due to baroreceptor disorders. By managing anesthesia meticulously during and after surgery, the operation was successfully performed, and the results of the post on the left leg strengthening motor increased from 2 to 4.





Neurosonology ◽  
1998 ◽  
Vol 11 (3) ◽  
pp. 118-122
Author(s):  
Hideo OTSUKI ◽  
Susumu NAKATANI ◽  
Hiroyuki NAKATA ◽  
Mami YAMASAKI ◽  
Masanobu YAMADA ◽  
...  








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