Comparison of electroencephalography and cerebral oximetry to determine the need for in-line arterial shunting in patients undergoing carotid endarterectomy

William J. Mauermann, Amy Z. Crepeau, Juan N. Pulido, James J. Lynch, Aaron Lobbestael, Gustavo Oderich, Gregory Alan Worrell

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To compare cerebral near-infrared regional spectroscopy (NIRS) with the 12-lead electroencephalogram for the detection of ischemia during carotid artery clamping for carotid endarterectomy (CEA). Design: Prospective, observational. Setting: Single, tertiary care center. Participants: Ninety patients older than 18 undergoing elective, unilateral CEA. Interventions: In addition to EEG monitoring, all patients underwent continuous blinded NIRS monitoring with sensors placed bilaterally above the supraorbital ridge. Measurements and Main Results: Seventeen patients were excluded, leaving 73 patients available for evaluation. Four patients (5.5%) required shunting based on EEG findings. Changes in cerebral oxygen saturation (rSO2) were assessed on the operative side using the average value for the 1 minute prior to cross-clamp and the lowest rSO2 value the first 5 minutes postclamp. Each 1% absolute decrease and each 1% relative decrease from baseline conferred a 50% increase in the need for shunt placement (OR 1.5; 95% CI (1.03-2.26); p = 0.03 and OR 1.4; 95% CI (1.02-1.81); p = 0.04 respectively). Sensitivity, specificity, and positive and negative predictive values were determined using significant cutoffs of≥5% absolute change or≥10% relative change. Positive predictive value was low (<25%) for both absolute and relative changes. Conclusions: A decrease in rSO2 during carotid cross-clamping for CEA is associated with EEG-determined need for shunting, but the positive predictive value is low. Using the above cutoffs in the current series would have resulted in an increase in the shunt rate by approximately 20% when it was not indicated by EEG.

Original languageEnglish (US)
Pages (from-to)1253-1259
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume27
Issue number6
DOIs
StatePublished - Dec 2013

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Oximetry
Carotid Endarterectomy
Electroencephalography
Near-Infrared Spectroscopy
Constriction
Physiologic Monitoring
Carotid Arteries
Tertiary Care Centers
Ischemia
Oxygen
Sensitivity and Specificity

Keywords

  • anesthesia
  • carotid endarterectomy
  • cerebral oximetry
  • electroencephalography
  • noninvasive regional spectroscopy
  • shunting
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Comparison of electroencephalography and cerebral oximetry to determine the need for in-line arterial shunting in patients undergoing carotid endarterectomy. / Mauermann, William J.; Crepeau, Amy Z.; Pulido, Juan N.; Lynch, James J.; Lobbestael, Aaron; Oderich, Gustavo; Worrell, Gregory Alan.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 27, No. 6, 12.2013, p. 1253-1259.

Research output: Contribution to journalArticle

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title = "Comparison of electroencephalography and cerebral oximetry to determine the need for in-line arterial shunting in patients undergoing carotid endarterectomy",
abstract = "Objective: To compare cerebral near-infrared regional spectroscopy (NIRS) with the 12-lead electroencephalogram for the detection of ischemia during carotid artery clamping for carotid endarterectomy (CEA). Design: Prospective, observational. Setting: Single, tertiary care center. Participants: Ninety patients older than 18 undergoing elective, unilateral CEA. Interventions: In addition to EEG monitoring, all patients underwent continuous blinded NIRS monitoring with sensors placed bilaterally above the supraorbital ridge. Measurements and Main Results: Seventeen patients were excluded, leaving 73 patients available for evaluation. Four patients (5.5{\%}) required shunting based on EEG findings. Changes in cerebral oxygen saturation (rSO2) were assessed on the operative side using the average value for the 1 minute prior to cross-clamp and the lowest rSO2 value the first 5 minutes postclamp. Each 1{\%} absolute decrease and each 1{\%} relative decrease from baseline conferred a 50{\%} increase in the need for shunt placement (OR 1.5; 95{\%} CI (1.03-2.26); p = 0.03 and OR 1.4; 95{\%} CI (1.02-1.81); p = 0.04 respectively). Sensitivity, specificity, and positive and negative predictive values were determined using significant cutoffs of≥5{\%} absolute change or≥10{\%} relative change. Positive predictive value was low (<25{\%}) for both absolute and relative changes. Conclusions: A decrease in rSO2 during carotid cross-clamping for CEA is associated with EEG-determined need for shunting, but the positive predictive value is low. Using the above cutoffs in the current series would have resulted in an increase in the shunt rate by approximately 20{\%} when it was not indicated by EEG.",
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author = "Mauermann, {William J.} and Crepeau, {Amy Z.} and Pulido, {Juan N.} and Lynch, {James J.} and Aaron Lobbestael and Gustavo Oderich and Worrell, {Gregory Alan}",
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T1 - Comparison of electroencephalography and cerebral oximetry to determine the need for in-line arterial shunting in patients undergoing carotid endarterectomy

AU - Mauermann, William J.

AU - Crepeau, Amy Z.

AU - Pulido, Juan N.

AU - Lynch, James J.

AU - Lobbestael, Aaron

AU - Oderich, Gustavo

AU - Worrell, Gregory Alan

PY - 2013/12

Y1 - 2013/12

N2 - Objective: To compare cerebral near-infrared regional spectroscopy (NIRS) with the 12-lead electroencephalogram for the detection of ischemia during carotid artery clamping for carotid endarterectomy (CEA). Design: Prospective, observational. Setting: Single, tertiary care center. Participants: Ninety patients older than 18 undergoing elective, unilateral CEA. Interventions: In addition to EEG monitoring, all patients underwent continuous blinded NIRS monitoring with sensors placed bilaterally above the supraorbital ridge. Measurements and Main Results: Seventeen patients were excluded, leaving 73 patients available for evaluation. Four patients (5.5%) required shunting based on EEG findings. Changes in cerebral oxygen saturation (rSO2) were assessed on the operative side using the average value for the 1 minute prior to cross-clamp and the lowest rSO2 value the first 5 minutes postclamp. Each 1% absolute decrease and each 1% relative decrease from baseline conferred a 50% increase in the need for shunt placement (OR 1.5; 95% CI (1.03-2.26); p = 0.03 and OR 1.4; 95% CI (1.02-1.81); p = 0.04 respectively). Sensitivity, specificity, and positive and negative predictive values were determined using significant cutoffs of≥5% absolute change or≥10% relative change. Positive predictive value was low (<25%) for both absolute and relative changes. Conclusions: A decrease in rSO2 during carotid cross-clamping for CEA is associated with EEG-determined need for shunting, but the positive predictive value is low. Using the above cutoffs in the current series would have resulted in an increase in the shunt rate by approximately 20% when it was not indicated by EEG.

AB - Objective: To compare cerebral near-infrared regional spectroscopy (NIRS) with the 12-lead electroencephalogram for the detection of ischemia during carotid artery clamping for carotid endarterectomy (CEA). Design: Prospective, observational. Setting: Single, tertiary care center. Participants: Ninety patients older than 18 undergoing elective, unilateral CEA. Interventions: In addition to EEG monitoring, all patients underwent continuous blinded NIRS monitoring with sensors placed bilaterally above the supraorbital ridge. Measurements and Main Results: Seventeen patients were excluded, leaving 73 patients available for evaluation. Four patients (5.5%) required shunting based on EEG findings. Changes in cerebral oxygen saturation (rSO2) were assessed on the operative side using the average value for the 1 minute prior to cross-clamp and the lowest rSO2 value the first 5 minutes postclamp. Each 1% absolute decrease and each 1% relative decrease from baseline conferred a 50% increase in the need for shunt placement (OR 1.5; 95% CI (1.03-2.26); p = 0.03 and OR 1.4; 95% CI (1.02-1.81); p = 0.04 respectively). Sensitivity, specificity, and positive and negative predictive values were determined using significant cutoffs of≥5% absolute change or≥10% relative change. Positive predictive value was low (<25%) for both absolute and relative changes. Conclusions: A decrease in rSO2 during carotid cross-clamping for CEA is associated with EEG-determined need for shunting, but the positive predictive value is low. Using the above cutoffs in the current series would have resulted in an increase in the shunt rate by approximately 20% when it was not indicated by EEG.

KW - anesthesia

KW - carotid endarterectomy

KW - cerebral oximetry

KW - electroencephalography

KW - noninvasive regional spectroscopy

KW - shunting

KW - stroke

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