Document Detail


Value of preoperative EEG for carotid endarterectomy.
MedLine Citation:
PMID:  9794269     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: This study was designed to determine whether the preoperative, baseline electroencephalogram (EEG) can be used for intraoperative decision making during carotid endarterectomy, and to identify circumstances where the EEG can be eliminated. METHODS: The charts of all patients undergoing carotid endartectomy at the authors' institution from June 1991 to May 1995 were reviewed to identify those patients that had adequate pre- and intraoperative EEG monitoring. EEGs during 331 carotid endartectomies in 303 patients were coded without knowledge of outcome; primary and secondary endpoints were EEG changes with clamping and clinical outcome, respectively. RESULTS: The incidence of mortality and major neurological morbidity was 1.8%. Baseline-EEGs were abnormal in 105 patients (32%). Whereas baseline-EEG changes were highly predictive of EEG changes after anesthetic induction (P < .0001), they were not predictive of EEG changes with clamping or of clinical outcome. Prior stroke (CVA) predicted abnormal baseline-EEGs (P < .0001) and abnormal post-anesthetic EEGs (P < .0001) but did not predict changes with clamping or perioperative CVA. EEG changes with clamping occurred during 18% of operations; such changes were predicted only by contralateral occlusion (P < .0016) and EEG changes during a prior contralateral carotid endartectomy (P < .0001). The only variable that predicted an adverse neurological outcome was the presence of contralateral occlusion, which increased the likelihood of a perioperative neurological event seven-fold (P = .0038). Clinical outcomes in the 57 of 105 patients with abnormal baseline-EEGs and the 49 of 83 with prior CVA who were shunted were not different from those who were not. CONCLUSIONS: baseline-EEG is not of value for the prediction of adverse events during carotid endartectomy and can be eliminated. Because contralateral occlusion is highly predictive of changes with clamping, and patients undergoing a second carotid endartectomy will usually manifest EEG changes identical to those at the first, operative EEG monitoring can also be eliminated from both these circumstances. Finally, prior stroke does not lead to a higher incidence of clamp-induced EEG changes, and thus is not an indication for shunting in and of itself.
Authors:
K A Illig; J L Burchfiel; K Ouriel; J A DeWeese; C K Shortell; R M Green
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Cardiovascular surgery (London, England)     Volume:  6     ISSN:  0967-2109     ISO Abbreviation:  Cardiovasc Surg     Publication Date:  1998 Oct 
Date Detail:
Created Date:  1998-12-22     Completed Date:  1998-12-22     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9308765     Medline TA:  Cardiovasc Surg     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  490-5     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of Rochester Medical Center, NY 14621, USA. killig@frontiernet.net
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MeSH Terms
Descriptor/Qualifier:
Brain Ischemia / diagnosis*,  epidemiology
Electroencephalography* / utilization
Endarterectomy, Carotid*
Humans
Incidence
Intraoperative Complications / diagnosis*,  epidemiology
Monitoring, Intraoperative
Postoperative Complications / epidemiology
Predictive Value of Tests
Preoperative Care
Risk Factors
Comments/Corrections
Comment In:
Cardiovasc Surg. 1999 Mar;7(2):268   [PMID:  10353687 ]

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


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