None listed
Conditions
Brief summary
Introduction: Carotid endarterectomy (CEA) is an established surgical procedure for patients with high-grade carotid artery stenosis. Cerebral hypoperfusion after clamping the carotid artery can lead to the development of new strokes or worsen existing damage. Near-infrared spectroscopy (NIRS) provides continuous and non-invasive monitoring of cerebral oxygenation, allowing for early detection of cerebral ischemia due to hypoperfusion in critical patients and a reduction in early complications. Postoperative cognitive dysfunction (POCD) refers to changes in cognitive function following surgery and anesthesia. Methods: In this prospective and observational study, our aim is to evaluate whether cerebral desaturation, as assessed by NIRS, contributes to the occurrence of POCD. Hemodynamic and NIRS assessments were recorded at various time points: baseline, post-intubation, pre-clamping, 5th and 10th minutes after carotid clamping, 5th minutes after unclamping, pre-extubation, and the end of the operation. The Mini-Mental Status Examination was administered to patients on the day before surgery and on the second day after surgery. Results: Cerebral desaturation was observed in 33% of patients. Regional cerebral oxygen saturation (rSO2) showed a slight decrease in the early stages after clamping the carotid artery. During the clamping period, rSO2 values increased, and by the end of the operation, they had returned to baseline or even exceeded baseline levels. We did not identify any cases of POCD during the early postoperative period. Conclusion: NIRS is a practical and effective method for detecting cerebral hypoperfusion. However, based on our study, we were unable to establish a correlation between NIRS values and the occurrence of POCD
Interventions
A Standardized Mini Mental Test was administered to determine the baseline cognitive function level of the patients 24 hours before the operation. Patients admitted to the operating room underwent electrocardiography (ECG), peripheral oxygen saturation (SpO2), invasive blood pressure monitoring (radial artery), esophageal temperature measurement, and Near-Infrared Spectroscopy (NIRS) monitoring. Arterial blood pressure (systolic/diastolic/mean), heart rate (HR), oxygen saturation (SatO2), and ce
A Standardized Mini Mental Test was administered to determine the baseline cognitive function level of the patients 24 hours before the operation. Patients admitted to the operating room underwent electrocardiography (ECG), peripheral oxygen saturation (SpO2), invasive blood pressure monitoring (radial artery), esophageal temperature measurement, and Near-Infrared Spectroscopy (NIRS) monitoring. Arterial blood pressure (systolic/diastolic/mean), heart rate (HR), oxygen saturation (SatO2), and cerebral tissue oxygen saturation (rSO2) on the operative side and contralateral side were noted in the case form at baseline (T1), 5 minutes after intubation (T2), before carotid clamping (T3), the 5th (T4) and 10th (T5) minutes after carotid clamping, 5th minutes after unclamping (T6), preextubation (T7), and the end of the operation (T8). Two days after the operation, the mini-mental test was repeated by the same physician. Cerebral desaturation was defined as a decrease of 25% or more in the baseline value of near-infrared spectroscopy (NIRS) or an NIRS value below 50%. The patients were divided into two groups: group I included those who experienced cerebral desaturation, and group II consisted of those who did not experience desaturation (normal group). Demographic data, NIRS values, complications, and changes in the mini-mental test were analyzed to determine if there were significant statistical differences between the two groups. The same physician performed the Standardized Mini Mental Test and took around 20 minutes to complete.
Sponsors
Cengiz Sahutoglu
Eligibility
Sex/Gender
All
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
The patients who underwent carotid endarterectomy due to carotid stenosis
Exclusion criteria
Patients with communication problems, illiteracy, and inability to complete the tests successfully, sedative, antidepressant, or antiepileptic medication use, cerebrovascular or psychiatric diseases, and alcohol or substance dependence were excluded from the study.
Outcome results
None listed