Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery
- Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation (rScO2) during cardiac surgery but is less established during non-cardiac surgery. This systematic review aimed (i) to determine the non-cardiac surgical procedures that provoke a reduction in rScO2 and (ii) to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome. The PubMed and Embase database were searched from inception until April 30, 2013 and inclusion criteria were intraoperative NIRS determined rScO2 in adult patients undergoing non-cardiac surgery. The type of surgery and number of patients included were recorded. There was included 113 articles and evidence suggests that rScO2 is reduced during thoracic surgery involving single lung ventilation, major abdominal surgery, hip surgery, and laparoscopic surgery with the patient placed in anti-Tredelenburg's position. Shoulder arthroscopy in the beach chair and carotid endarterectomy with clamped internal carotid artery (ICA) also cause pronounced cerebral desaturation. A >20% reduction in rScO2 coincides with indices of regional and global cerebral ischemia during carotid endarterectomy. Following thoracic surgery, major orthopedic, and abdominal surgery the occurrence of postoperative cognitive dysfunction (POCD) might be related to intraoperative cerebral desaturation. In conclusion, certain non-cardiac surgical procedures is associated with an increased risk for the occurrence of rScO2. Evidence for an association between cerebral desaturation and postoperative outcome parameters other than cognitive dysfunction needs to be established.
Keywords: tissue oxygenation, brain, muscle, cerebral cortex, intraoperative monitoring
Citation: Nielsen HB (2014) Systematic review of near-infrared spectroscopy determined cerebral oxygenation during non-cardiac surgery. Front. Physiol. 5:93. doi: 10.3389/fphys.2014.00093
Received: 30 September 2013; Accepted: 21 February 2014;
Published online: 17 March 2014.
Edited by:Patrice Brassard, Laval University, Canada
Reviewed by:Shawnda A. Morrison, Acadia University, Canada
Hilary P. Grocott, University of Manitoba, Canada
Copyright © 2014 Nielsen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Henning B. Nielsen, Department of Anesthesia, Rigshospitalet, University of Copenhagen, Rigshospitalet 2041, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark e-mail: email@example.com