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Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia Annals of Cardiac Anaesthesia
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Table of Contents
LETTERS TO THE EDITOR  
Year : 2020  |  Volume : 23  |  Issue : 4  |  Page : 544
Monitoring of carotid endarterectomy


Cardiac Center, Sultan Qaboos Hospital, Salalah, Sultanate of Oman

Click here for correspondence address and email

Date of Submission13-Apr-2019
Date of Acceptance19-Apr-2020
Date of Web Publication19-Oct-2020
 

How to cite this article:
Rawat RS, Al Maashani SM. Monitoring of carotid endarterectomy. Ann Card Anaesth 2020;23:544

How to cite this URL:
Rawat RS, Al Maashani SM. Monitoring of carotid endarterectomy. Ann Card Anaesth [serial online] 2020 [cited 2020 Nov 24];23:544. Available from: https://www.annals.in/text.asp?2020/23/4/544/298540




To the Editor,

We read the article written by Dr Dilek Ceyhan et al. on the use of cerebral oximeter in carotid endarterectomy (CEA) surgery.[1] We do agree that cerebral oxymeter is a good monitoring device and is helpful to assess brain tissue oxygenation level in the patients undergoing surgery, but we cannot rely completely on it for CEA.

Carotid endarterectomy is a surgical procedure to reduce the risk of stroke by correcting stenosis in common carotid artery or in internal carotid artery. Endarterectomy is the removal of material from the inside of an artery. There is a high chance of neurological impairment during the procedure. Moreover, reflex bradycardia or heart blocks are frequently caused by the manipulation of the carotid baroreceptors.

We can use cerebral oxymeter device to assess tissue oxygenation. The advantage is that, it is noninvasive technique, does not require pulsatile blood flow, and is easy to interpret. The monitor differentiates two forms of oxygenated and deoxygenated hemoglobin and determines the regional saturation (rSO2) in the frontal lobes.[2] So it does not require only pulsatile blood flow. It determines saturation mainly form venous blood (75%) and also form arterial blood (25%). It has the capability to calculate oxygen saturation of brain tissue even in hypothermia, severe cerebral ischemia and during circulatory arrest.

There are certain limitations to it's use. One should keep in mind that the device uses near infrared spectrometry to estimate oxygen saturation in a sample volume of one small region of brain frontal lobe. It does not involve whole brain. We can get an idea of oxygen status of a small part of brain, so we cannot completely rely on its value in order to protect the cerebral function.[3] Continuous monitoring of the vitals with prompt interventions, use of the shunt, maintaining normocarbia and keeping high mean arterial pressure during arterial clamp are important to successfully manage patient for carotid endarterectomy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ceyhan D, Ovali C. The effect of cerebral oximeter use on the shunt placement concerning carotid endarterectomy surgery. Ann Card Anaesth 2019;22:158-61.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Colak Z, Borojevic M, Ivancan V, Gabelica R, Biocina B, Majeric-Kogler V. The relationship between prolonged cerebral oxygen desaturation and postoperative outcome in patients undergoing coronary artery bypass grafting. Coll Antropol 2012;36:381-8.  Back to cited text no. 2
    
3.
Kunst G, Milan Z. Cerebral oximetry: Another blow to non-invasive monitoring? Anaesthesia 2017;72:1435-8.  Back to cited text no. 3
    

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Correspondence Address:
Rajinder Singh Rawat
Cardiac Center, Sultan Qaboos Hospital, Salalah
Sultanate of Oman
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.ACA_60_19

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