Document Detail

Cerebral monitors versus regional anesthesia to detect cerebral ischemia in patients undergoing carotid endarterectomy: a meta-analysis.
MedLine Citation:
PMID:  23385550     Owner:  NLM     Status:  Publisher    
PURPOSE: The aim of this meta-analysis is to compare the ability of different types of brain monitoring systems vs clinical monitoring of the brain function to detect cerebral ischemia during cross-clamping of the carotid artery under regional anesthesia. METHODS: In May 2012, a search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Ovid MEDLINE(®) for prospective trials with 20 patients or more where a cerebral monitoring system was compared with clinical brain monitoring during a carotid endarterectomy performed under regional anesthesia. The quality of the study was evaluated with the Cochrane Collaboration's tool. Data were extracted independently by the two investigators. RESULTS: Data could be extracted for 4,664 measurements taken from 29 studies: transcranial Doppler (TCD) = 739; cerebral saturation = 320; stump pressure = 2,549; electroencephalography (EEG) = 742; evoked potentials = 187; jugular venous saturation = 79; and jugular venous lactate = 48. The pooled diagnostic odds ratios (DOR) and 95% confidence intervals (CI) were obtained for EEG, TCD, stump pressure, evoked potentials, and cerebral saturation: (DOR 65.3; 95% CI 20.5 to 207.7; I(2) [56.8%]); (DOR 58.1; 95% CI 23.0 to 146.3; I(2) [24.9%]); (DOR 27.8; 95% CI 13.4 to 57.9; I(2) [59.9]); (DOR 17.2; 95% CI 2.4 to 123.9 I(2) [69.1]); and (DOR 12.1; 95% CI 3.5 to 41.2; I(2) [30.8]), respectively. Sequential testing with stump pressure 25 mmHg followed by either TCD or EEG delivered the best post-test probabilities. For EEG, the DOR increases with the number of channels used (P = 0.03). CONCLUSION: A combination of stump pressure and either TCD or EEG appears to deliver the best results for detecting brain ischemia during carotid artery cross-clamping. Electroencephalography should be used with a high number of channels.
Joanne Guay; Sandra Kopp
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-2-6
Journal Detail:
Title:  Canadian journal of anaesthesia = Journal canadien d'anesthesie     Volume:  -     ISSN:  1496-8975     ISO Abbreviation:  Can J Anaesth     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-2-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701709     Medline TA:  Can J Anaesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Anesthesiology, University of Montreal, Montreal, QC, Canada,
Vernacular Title:
Comparaison des moniteurs cérébraux et de l'anesthésie régionale pour dépister l'ischémie cérébrale chez les patients subissant une endartériectomie carotidienne: une méta-analyse.
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