Peroperative Monitoring of Tissue Oximetry and Peroperative Use of Hypothermi a in Surgery on Cerebral Ane urysms

Czech version

Authors: M. Smrčka ¹; K. Ďuriš ¹; V. Juráň ¹; E. Neuman ¹; M. Kýr ²
Authors‘ workplace: Neurochirurgická klinika LF MU a FN Brno, 2Institut biostatistiky a analýz MU, Brno ¹
Published in: Cesk Slov Neurol N 2009; 72/105(3): 245-249
Category: Original Paper

Overview

Introducti on:
During surgery on cerebral artery ane urysm, there is a risk of ischaemi a ca used by the use of temporary clips, brain tissue retracti on or mechanically driven vasospasms ca used by the manipulati on of brain vessels. Nowadays, tissue oxymetry is experimentally used for e arly detecti on of ischaemi a conditi oned by vasospasms. The aim of the rese arch is to evalu ate the possible use of brain tissue oximetry during surgery on cerebral artery ane urysm.

Materi al and methods:

We enrolled 25 pati ents who had been operated on for ane urysm. Pati ents were maintained in mild controlled hypothermi a during the operati on. The monitored parameters were brain tissue oxygen pressure (PbtO₂), jugular bulb oxygen saturati on (SvjO₂), me an arteri al pressure (MAP), and fracti on of inspired oxygen (FiO₂).

Results:
In the study gro up, no correlati on exists either between peroperative values of PbtO₂ and age, sex, Hunt Hess score, o utcome, localizati on or side of ane urysm or between peroperative values of PbtO₂ and the SvjO₂ or FiO₂. A correlati on between PbtO₂ and MAP (R = 0.44; p < 0.001) in the study gro up has been demonstrated. The incre asing durati on of the manipulati on of brain vessels poses a significant risk factor for a fall in PbtO₂ values (p < 0.001). In all cases, the PbtO₂ values decre ased after applying a temporary clip. In pati ents with peroperatively recorded peri ods of PbtO₂ decre ase, the occurrence of ischemic changes on postoperative CT was comparable to the gro up in which no PbtO₂ decre ase was peroperatively recorded.

Conclusi on:
We consider PbtO₂ monitoring of surgery on cerebral artery ane urysms to be benefici al as it informs the surge on abo ut the length and depth of ischaemi a, thus drawing attenti on to the need for a change in the tactic of the surgery.

Key words:
oxymetry – hypothermia – aneurysm

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