Abstract
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.
Highlights
Near-infrared spectroscopy (NIRS) is used to monitor regional cerebral oxygenation during cardiac surgery but is less established during non-cardiac surgery
During cardiac surgery NIRS is used for anesthetic management of the circulation (Murkin and Arango, 2009) while, as indicated by the number of review papers there is no standard recommendation for the use of NIRS in non-cardiac surgical procedures other than in carotid endarterectomy
1055 papers did not met the inclusion criteria: 321 papers were on cardiacthoracic and/or pediatric/fetal issues, 54 articles addressed studies in animals, and 99 papers were reviews and/or comments predominantly addressing cardiac surgical patients, 67 articles included head-trauma or neurological patients, 149 articles were in non-English language and 145 papers did not address intraoperative issues
Summary
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. Major orthopedic, and abdominal surgery the occurrence of postoperative cognitive dysfunction (POCD) might be related to intraoperative cerebral desaturation. During cardiac surgery NIRS is used for anesthetic management of the circulation (Murkin and Arango, 2009) while, as indicated by the number of review papers there is no standard recommendation for the use of NIRS in non-cardiac surgical procedures other than in carotid endarterectomy A systematic review was undertaken (i) to determine the noncardiac surgical procedures that provoke a reduction in rScO2 and (ii) to evaluate whether an intraoperative reduction in rScO2 influences postoperative outcome such as cognitive dysfunction. Publications included for the review are presented in a table with inclusion of the surgical speciality, the number of patients included in each article, the NIRS device used, and whether cerebral oxygenation was changed intraoperatively
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