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001-es BibID:BIBFORM106083
Első szerző:Gyöngyösi Zoltán (1977-)
Cím:The value of transcranial Doppler monitoring of cerebral blood flow changes during carotid endarterectomy performed under regional anesthesia : A case series / Gyöngyösi Zoltán, Farkas Orsolya, Papp Lóránd, Bodnár Fruzsina, Végh Tamás, Fülesdi Béla
Dátum:2022
ISSN:2081-3856 2081-6936
Megjegyzések:Abstract: Recent evidence suggests no difference between patient outcomes when carotid endarterectomies (CEAs) are performed under general or regional anesthesia. However, for detecting the need for a shunt, general anesthesia has the drawback of monitoring needs in the intraoperative setting. In the present study, we attempted to perform intraoperative transcranial Doppler (TCD) monitoring for CEAs performed under intermediate plexus block to describe cerebral hemodynamic changes during different phases of the procedure. Patients and methods ? Patients with unilateral hemodynamically significant carotid stenosis scheduled for elective CEAs were included. Ultrasound-guided intermediate plexus block was used for regional anesthesia. TCD monitoring of the middle cerebral artery mean blood flow velocity (MCAV) was performed throughout the procedure. MCAVs were offline analyzed during different phases of CEA: (1) resting state, before regional block, (2) after block, before incision, (3) before cross-clamp, (4) after cross-clamp, (5) 5 min after cross-clamp, (6) 10 min after cross-clamp, (7) after declamping, and (8) during the postoperative period (4?6 h). Results ? Shunt insertion based on the deterioration of neurological symptoms after cross-clamping was necessary for 11/66 patients (16.6%). In these symptomatic patients, the ipsilateral percent decrease of the MCAV was more than 70% in 8 out of 11 cases (72.7%). In asymptomatic patients, without shunt insertion, the average decrease of MCAV was less than 50%. Conclusions ? Neurological symptoms referring to cerebral ischemia may be superior to TCD monitoring of cerebral blood flow for detecting the necessity of a shunt. Regional anesthesia enables reliable, symptom-based monitoring of CEAs.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
carotid endarterectomy
regional anesthesia
transcranial Doppler monitoring
Megjelenés:Translational Neuroscience. - 13 : 1 (2022), p. 476-482. -
További szerzők:Farkas Orsolya Papp Lóránd Bodnár Fruzsina (1978-) (orvos) Végh Tamás (1975-) (aneszteziológus, intenzív terápiás szakorvos) Fülesdi Béla (1961-) (aneszteziológus)
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