Cerebral Oximetry in Patients Undergoing Carotid Endarterectomy Under Regional Anesthesia

Abstract

Background and Purpose Near-infrared spectroscopy is a technique that can potentially monitor changes in cerebral oxygenation. There are at present limited clinical data regarding the value of this technology in relating neurological outcome to cerebrovascular hemoglobin oxygen saturation (Sc o 2 ). This investigation reports changes in Sc o 2 due to carotid cross-clamping during carotid endarterectomy in awake patients. Methods Sc o 2 was monitored in 38 adult patients undergoing 41 carotid endarterectomies under regional anesthesia. Ipsilateral and contralateral hemispheres were monitored simultaneously during 36 operations, with ipsilateral monitoring alone in the remaining 5 operations. Results No significant difference was detected between ipsilateral and contralateral Sc o 2 during preclamp or postclamp periods. Carotid cross-clamping caused a statistically significant ( P <.01) decrease in the ipsilateral Sc o 2 , which decreased from 71.8±6.91% to 65.8±8.2%, while the contralateral Sc o 2 remained stable at 70.5±7.5% and 70.3±7.9%. The change in ipsilateral Sc o 2 ranged from +2.6% to −28.6% of the preclamp value. The difference between ipsilateral and contralateral Sc o 2 during cross-clamping was statistically significant ( P <.001). The duration of cross-clamping was 39±11 minutes (range, 18 to 89 minutes). The decrease in ipsilateral Sc o 2 was highly variable from patient to patient and did not correlate with the duration of cross-clamping. Conclusions These results suggest that carotid artery occlusion causes a statistically significant but variable decrease in Sc o 2 in the majority of patients. Data in this investigation provide a range of Sc o 2 values that was not associated with a clinically detectable neurological dysfunction.