Document Detail

Transcranial Doppler ultrasonography as a screening technique for detection of a patent foramen ovale before surgery in the sitting position.
MedLine Citation:
PMID:  11020748     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Venous air embolism has been reported to occur in 23-45% of patients undergoing neurosurgical procedures in the sitting position. If venous air embolism occurs, a patent foramen ovale (PFO) is a risk factor for paradoxical air embolism and its sequelae. Preoperative screening for a PFO is therefore recommended by some investigators. The reference standard for identifying a PFO is contrast-enhanced transesophageal echocardiography (c-TEE). Contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and contrast-enhanced transthoracic echocardiography (c-TTE) are noninvasive alternative methods, but so far there are no studies as to their diagnostic validity in neurosurgical patients. METHODS: The sensitivity and specificity of c-TCD and c-TTE in detecting a PFO were determined in a prospective study using c-TEE as the reference standard. Preoperative c-TCD, c-TTE, and c-TEE studies were performed during the Valsalva maneuver after intravenous echo-contrast medium (D-Galactose, Echovist-300, Schering AG, Berlin, Germany) was administered in 92 consecutive candidates (47 men and 45 women; mean age, 51 yr; range, 25-72 yr) before neurosurgical procedures in the sitting position. RESULTS: A PFO was detected in 24 of the 92 patients (26.0%) using c-TEE. c-TCD correctly identified 22 patients, whereas c-TTE only correctly identified 10. This corresponds to a sensitivity of 0.92 for c-TCD and 0.42 for c-TTE. The negative predictive value was 0.97 for c-TCD compared with 0.83 for c-TTE. The prevalence of a PFO in patients with a posterior fossa lesion was 27%, and in the group with cervical disc herniation was 24% as detected by c-TEE. The incidence of intraoperative venous air embolism was 35% in cases of cervical foraminotomy and 75% in posterior fossa surgery as detected by c-TEE. CONCLUSIONS: c-TCD is a highly sensitive and highly specific method for detecting a PFO. Because c-TCD is noninvasive, it may be more suitable than c-TEE for routine preoperative screening for a PFO. C-TTE is not reliable in detecting a PFO.
R Stendel; H J Gramm; K Schröder; C Lober; M Brock
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article    
Journal Detail:
Title:  Anesthesiology     Volume:  93     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2000 Oct 
Date Detail:
Created Date:  2000-10-13     Completed Date:  2000-10-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  971-5     Citation Subset:  AIM; IM    
Departments of Neurosurgery, Anesthesiology and Critical Care Medicine, and Cardiology and Pulmonology, Benjamin Franklin Medical Center, Freie Universität Berlin, Berlin, Germany.
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MeSH Terms
Contrast Media / therapeutic use
Echocardiography, Transesophageal / methods
Embolism, Air / etiology
Embolism, Paradoxical / etiology
Heart Septal Defects, Atrial / complications,  ultrasonography*
Middle Aged
Neurosurgical Procedures / adverse effects,  methods*
Posture / physiology
Predictive Value of Tests
Preoperative Care
Prospective Studies
Sensitivity and Specificity
Ultrasonography, Doppler, Transcranial / methods*
Reg. No./Substance:
0/Contrast Media
Comment In:
Anesthesiology. 2001 Sep;95(3):808-9   [PMID:  11575563 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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