Cerebral Autoregulation Assessment through Near-Infrared Spectroscopy and Arterial Monitoring: Advancements and Clinical Implications

Abstract

Cerebral autoregulation, maintaining stable cerebral blood flow across varying arterial pressures, is vital in-patient care during surgery. Traditional views suggest a mean arterial pressure range of 50-150 mm Hg for effective autoregulation. However, patient-specific variations in autoregulatory patterns, particularly in cases of impaired autoregulation, call for personalized hemodynamic and blood pressure management during surgical procedures. In the evaluation of cerebral autoregulation, NIRS serves as a beneficial monitoring tool. The cerebral oximetry index, correlating cerebral oxygen saturation with perfusion pressure, aids in determining autoregulation limits. The literature shows varying impacts of vasoactive drugs on patients with different autoregulatory responses, emphasizing the need for individualized care. In summary, NIRS is crucial for monitoring cerebral autoregulation, and adjusting arterial blood pressure targets based on NIRS data could improve prevention of cerebral hyper/hypoperfusion. This approach, moving away from a generalized strategy, advocates for a more customized, physiology-based patient management.