Key-points of cerebral hemodynamic therapy in neuro critical cases / 中国实用内科杂志

Cerebral hemodynamic therapy has the ultimate goal of brain function improvements.The therapeutic endpoint is to optimize cerebral perfusion in order to stop primary or secondary injury and promote brain function recovery.Clinically,cerebral perfusion can be indirectly measured by brain oxygenation instruments including Near-infrared spectroscopy.Cerebral blood flow optimization should be the core target of cerebral hemodynamic therapy.Transcranial Color-Coded Duplex and Transcranial Doppler sonography are essential techniques to quantify cerebral blood flow,evaluate vascular resistance,and alert for increased intracranial pressure non-invasively by bedside measurements of optic nerve sheath diameter.Hemodynamic targets including blood pressure,cardiac output,and oxygen delivery require extra considerations beyond traditional hemodynamic therapy in order to promote cerebral function.Brain electricity monitoring should be read with caution where low brain activity might indicate insufficient cerebral perfusion,whereas overactive brain function shows high oxygen consumption.In clinical practice,the integrated monitoring of cerebral blood flow,brain oxygenation and brain function would improve the management of neurocritical patients.

Anesthetic Management of Carotid Endarterectomy under Cervical Plexus Block / 대한마취과학회지

BACKGROUND: The purpose of this study was to determine the possibility and safety of performing carotid endarterectomy under cervical plexus block. METHODS: Carotid endarterectomy was performed in 30 cases with deep and superficial cervical plexus block, to monitor the patient for cerebral ischemia in the awake state. The toy horn was placed in the contralateral hand in each case and was activated by the patient on command and patients had counted ten repeatedly during carotid clamping. Patients who had not been experienced in the change of mental status or motor response had been operated without a shunt. RESULTS: Cerebral ischemia requiring shunt was observed in one case (3.3%). There were no permanent neurologic deficit and major cardiovascular complication and mortality. CONCLUSIONS: Carotid endarterectomy under cervical plexus block allows direct and precise observation of the patient's central nervous system function during the operation.

Cerebral Oxygen Saturation Monitoring during Carotid Endarterectomy: A case report / 대한마취과학회지

Cerebral oximetry based on the principle of near infrared spectroscopy is a relatively new technique that can monitor changes in cerebral oxygenation. Limited clinical experience with this monitoring technique exists, and the critical level of cerebral oxygen saturation below which neuronal damage takes place, has not been established. However, cerebral oximetry enables noninvasive and continuous cerebral oxygen saturation monitoring. It provides valuable information during carotid endarterectomy and other neurologic conditons. We experienced cerebral oxygen saturation changes during carotid endarterectomy. We monitored electroencephalography (EEG) simultaneously. During clamping of common carotid artery, there was a decrease in cerebral oxygen saturation from 65% to 58% without EEG changes. During clamping of external carotid artery, there was a decrease in cerebral oxygen saturation from 65% to 60% without EEG change.