| The utility of using the bispectral index-Vista for detecting cross-clamping decline in cerebral blood flow velocity. | |
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MedLine Citation:
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PMID: 20679941 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Patients undergoing carotid endarterectomy for extracranial internal carotid artery stenosis are at risk of cerebral ischemia/hypoperfusion. Criterion recommended by European and American committees to determine whether to place a shunt consisted of a decline in transcranial Doppler ultrasonography-measured middle cerebral artery blood flow velocity (MCBFV) to < 30% to 40% of intraoperative preclamp value. OBJECTIVE: To assess the discriminative power of the bispectral index (BIS)-Vista monitor for detecting a 40% decline in MCBFV with cross-clamping. METHODS: In 20 patients undergoing carotid endarterectomy under remifentanil/propofol anesthesia, BIS-Vista data, MCBFV, and pulsatility index from bilaterally mounted BIS-Vista and transcranial Doppler monitors were continuously recorded. RESULTS: Coefficient of determination revealed good correlation (r = 0.763) between ipsilateral BIS-Vista and MCBFV after cross-clamping. BIS-Vista exhibited a high discriminative power of 0.850 (95% confidence interval, 0.455-0.966) area under the receiver-operating characteristic curve in detecting an ipsilateral 40% MCBFV decline. Two-way analysis of variance (location by time) suggests that BIS-Vista exhibited a global decline; ie, both BIS-Vistas declined when 1 carotid on either side was clamped because there was no significant interhemispheric difference (P = .112) in mean BIS-Vista values over time. CONCLUSION: Although we demonstrated good correlation and high discriminative power of the BIS-Vista monitor in depicting a MCBFV decline that could serve as indicator of decline in cerebral activity, BIS-Vista cannot be considered a reliable indicator of cerebral ischemia/hypoperfusion that could replace transcranial Doppler monitoring to determine whether a shunt is to be placed. |
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Authors:
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Ashraf A Dahaba; Ji Xiu Xue; Yang Hua; Qing Hai Liu; Guo Xun Xu; Yu Mei Liu; Xiu Feng Meng; Guo Guang Zhao; Peter H Rehak; Helfried Metzler |
Publication Detail:
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Type: Clinical Trial; Journal Article |
Journal Detail:
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Title: Neurosurgery Volume: 67 ISSN: 1524-4040 ISO Abbreviation: Neurosurgery Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-23 Completed Date: 2010-12-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7802914 Medline TA: Neurosurgery Country: United States |
Other Details:
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Languages: eng Pagination: ons102-7; discussion ons107 Citation Subset: IM |
Affiliation:
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Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Algorithms Blood Circulation Time / methods Blood Flow Velocity / physiology Carotid Stenosis / physiopathology*, surgery* Cerebrovascular Circulation / physiology* Electroencephalography / methods Electromyography Endarterectomy, Carotid / methods* Female Functional Laterality / physiology Humans Male Middle Aged Middle Cerebral Artery / physiopathology Monitoring, Intraoperative / methods* ROC Curve Ultrasonography, Doppler, Transcranial / methods |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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