Cerebral oximetry during carotid clamping: Is blood pressure raising necessary?

Enrico Giustiniano, Alessandra Alfano, Gian M. Battistini, Vittorio Gavazzeni, Maria R. Spoto, Franco Cancellieri

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

BACKGROUND: Carotid endarterectomy is subject to a significant risk of intraoperative stroke. Anesthetic management of patients must provide optimal monitoring of cerebral blood perfusion to establish whether intraluminal carotid shunting is necessary. Cerebral oximetry (regional cerebral oxygen saturation, rSO2) measurement can ascertain whether brain perfusion is adequate. During carotid cross-clamping, a rise of blood pressure may be required to guarantee a collateral blood supply throughout the circle of Willis. We retrospectively evaluated the relationship between blood pressure and rSO2 in our experience. METHODS: We analyzed data of 104 patients submitted to carotid endarterectomy in narcosis for carotid stenosis of 74 ± 9%. We compared the rSO2 and invasive blood pressure variations before, during and after carotid cross-clamping. RESULTS: After carotid closure, ipsilateral rSO2 was reduced significantly (from 64.8 ± 8.1% to 60.8 ± 8.1%; P = 0.0004), while systolic and mean blood pressure rose. The ipsilateral rSO2 returned to basal levels after unclamping, whereas blood pressure was lowered significantly (P = 0.001). Plotting rSO2 and blood pressure value, we found a poor relationship (R2 = 0.0003). CONCLUSION: During carotid cross-clamping, an excessive rise of blood pressure is not necessary to guarantee safe values of rSO2. On the contrary, hypertension could expose the patient to risk of cardiac accident. So we have modified our intraoperative strategy avoiding controlled hypertension for normotensive management during carotid clamping.

Original languageEnglish
Pages (from-to)522-528
Number of pages7
JournalJournal of Cardiovascular Medicine
Volume11
Issue number7
DOIs
Publication statusPublished - 2010

Fingerprint

Oximetry
Constriction
Blood Pressure
Carotid Endarterectomy
Perfusion
Circle of Willis
Hypertension
Stupor
Carotid Stenosis
Accidents
Anesthetics
Stroke
Oxygen
Brain

Keywords

  • Arterial blood pressure
  • Carotid endarterectomy
  • Near-infrared spectroscopy
  • Regional cerebral oxygen saturation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Cerebral oximetry during carotid clamping : Is blood pressure raising necessary? / Giustiniano, Enrico; Alfano, Alessandra; Battistini, Gian M.; Gavazzeni, Vittorio; Spoto, Maria R.; Cancellieri, Franco.

In: Journal of Cardiovascular Medicine, Vol. 11, No. 7, 2010, p. 522-528.

Research output: Contribution to journalArticle

Giustiniano, Enrico ; Alfano, Alessandra ; Battistini, Gian M. ; Gavazzeni, Vittorio ; Spoto, Maria R. ; Cancellieri, Franco. / Cerebral oximetry during carotid clamping : Is blood pressure raising necessary?. In: Journal of Cardiovascular Medicine. 2010 ; Vol. 11, No. 7. pp. 522-528.
@article{a8bad027b7334b8a97851b9732beaddb,
title = "Cerebral oximetry during carotid clamping: Is blood pressure raising necessary?",
abstract = "BACKGROUND: Carotid endarterectomy is subject to a significant risk of intraoperative stroke. Anesthetic management of patients must provide optimal monitoring of cerebral blood perfusion to establish whether intraluminal carotid shunting is necessary. Cerebral oximetry (regional cerebral oxygen saturation, rSO2) measurement can ascertain whether brain perfusion is adequate. During carotid cross-clamping, a rise of blood pressure may be required to guarantee a collateral blood supply throughout the circle of Willis. We retrospectively evaluated the relationship between blood pressure and rSO2 in our experience. METHODS: We analyzed data of 104 patients submitted to carotid endarterectomy in narcosis for carotid stenosis of 74 ± 9{\%}. We compared the rSO2 and invasive blood pressure variations before, during and after carotid cross-clamping. RESULTS: After carotid closure, ipsilateral rSO2 was reduced significantly (from 64.8 ± 8.1{\%} to 60.8 ± 8.1{\%}; P = 0.0004), while systolic and mean blood pressure rose. The ipsilateral rSO2 returned to basal levels after unclamping, whereas blood pressure was lowered significantly (P = 0.001). Plotting rSO2 and blood pressure value, we found a poor relationship (R2 = 0.0003). CONCLUSION: During carotid cross-clamping, an excessive rise of blood pressure is not necessary to guarantee safe values of rSO2. On the contrary, hypertension could expose the patient to risk of cardiac accident. So we have modified our intraoperative strategy avoiding controlled hypertension for normotensive management during carotid clamping.",
keywords = "Arterial blood pressure, Carotid endarterectomy, Near-infrared spectroscopy, Regional cerebral oxygen saturation",
author = "Enrico Giustiniano and Alessandra Alfano and Battistini, {Gian M.} and Vittorio Gavazzeni and Spoto, {Maria R.} and Franco Cancellieri",
year = "2010",
doi = "10.2459/JCM.0b013e32833246e7",
language = "English",
volume = "11",
pages = "522--528",
journal = "Journal of Cardiovascular Medicine",
issn = "1558-2027",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Cerebral oximetry during carotid clamping

T2 - Is blood pressure raising necessary?

AU - Giustiniano, Enrico

AU - Alfano, Alessandra

AU - Battistini, Gian M.

AU - Gavazzeni, Vittorio

AU - Spoto, Maria R.

AU - Cancellieri, Franco

PY - 2010

Y1 - 2010

N2 - BACKGROUND: Carotid endarterectomy is subject to a significant risk of intraoperative stroke. Anesthetic management of patients must provide optimal monitoring of cerebral blood perfusion to establish whether intraluminal carotid shunting is necessary. Cerebral oximetry (regional cerebral oxygen saturation, rSO2) measurement can ascertain whether brain perfusion is adequate. During carotid cross-clamping, a rise of blood pressure may be required to guarantee a collateral blood supply throughout the circle of Willis. We retrospectively evaluated the relationship between blood pressure and rSO2 in our experience. METHODS: We analyzed data of 104 patients submitted to carotid endarterectomy in narcosis for carotid stenosis of 74 ± 9%. We compared the rSO2 and invasive blood pressure variations before, during and after carotid cross-clamping. RESULTS: After carotid closure, ipsilateral rSO2 was reduced significantly (from 64.8 ± 8.1% to 60.8 ± 8.1%; P = 0.0004), while systolic and mean blood pressure rose. The ipsilateral rSO2 returned to basal levels after unclamping, whereas blood pressure was lowered significantly (P = 0.001). Plotting rSO2 and blood pressure value, we found a poor relationship (R2 = 0.0003). CONCLUSION: During carotid cross-clamping, an excessive rise of blood pressure is not necessary to guarantee safe values of rSO2. On the contrary, hypertension could expose the patient to risk of cardiac accident. So we have modified our intraoperative strategy avoiding controlled hypertension for normotensive management during carotid clamping.

AB - BACKGROUND: Carotid endarterectomy is subject to a significant risk of intraoperative stroke. Anesthetic management of patients must provide optimal monitoring of cerebral blood perfusion to establish whether intraluminal carotid shunting is necessary. Cerebral oximetry (regional cerebral oxygen saturation, rSO2) measurement can ascertain whether brain perfusion is adequate. During carotid cross-clamping, a rise of blood pressure may be required to guarantee a collateral blood supply throughout the circle of Willis. We retrospectively evaluated the relationship between blood pressure and rSO2 in our experience. METHODS: We analyzed data of 104 patients submitted to carotid endarterectomy in narcosis for carotid stenosis of 74 ± 9%. We compared the rSO2 and invasive blood pressure variations before, during and after carotid cross-clamping. RESULTS: After carotid closure, ipsilateral rSO2 was reduced significantly (from 64.8 ± 8.1% to 60.8 ± 8.1%; P = 0.0004), while systolic and mean blood pressure rose. The ipsilateral rSO2 returned to basal levels after unclamping, whereas blood pressure was lowered significantly (P = 0.001). Plotting rSO2 and blood pressure value, we found a poor relationship (R2 = 0.0003). CONCLUSION: During carotid cross-clamping, an excessive rise of blood pressure is not necessary to guarantee safe values of rSO2. On the contrary, hypertension could expose the patient to risk of cardiac accident. So we have modified our intraoperative strategy avoiding controlled hypertension for normotensive management during carotid clamping.

KW - Arterial blood pressure

KW - Carotid endarterectomy

KW - Near-infrared spectroscopy

KW - Regional cerebral oxygen saturation

UR - http://www.scopus.com/inward/record.url?scp=77953257821&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953257821&partnerID=8YFLogxK

U2 - 10.2459/JCM.0b013e32833246e7

DO - 10.2459/JCM.0b013e32833246e7

M3 - Article

C2 - 20527713

AN - SCOPUS:77953257821

VL - 11

SP - 522

EP - 528

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

IS - 7

ER -