Neurologic Monitoring in Aortic Arch Surgery: Evolving Techniques and Clinical Outcomes

Michael Dieleman^*
*Correspondence: Michael Dieleman, Department of Anesthesiology and Pain Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, AB T6G 2R3, Canada, Email:

Description

Aortic arch surgery presents a significant challenge due to the high risk of cerebral ischemia and neurological complications. Neurologic monitoring during aortic arch surgery plays a crucial role in assessing and preserving brain function. Over the years, various techniques have been developed and refined to improve the accuracy and reliability of neurologic monitoring, leading to better clinical outcomes. This research article provides an overview of the evolving techniques for neurologic monitoring in aortic arch surgery and their impact on patient outcomes. Aortic arch surgery is a complex and high-risk procedure that involves the repair or replacement of the aortic arch. While this surgical intervention is crucial for treating various aortic pathologies, it carries a significant risk of cerebral ischemia and subsequent neurological complications. The interruption of blood flow to the brain, manipulation of the aortic arch, and the systemic inflammatory response can all contribute to the potential for neurologic injury. Aortic arch surgery, including procedures such as aortic arch replacement and repair, is a complex surgical intervention associated with a considerable risk of cerebral ischemia and subsequent neurological complications. During aortic arch surgery, the interruption of blood flow to the brain, manipulation of the aortic arch, and systemic inflammatory response contribute to the potential for neurologic injury [1-3].

Therefore, accurate and timely neurologic monitoring is essential for early detection and intervention to mitigate these risks. Neurologic monitoring techniques in aortic arch surgery typically involve assessing cerebral blood flow, identifying ischemic insults, and detecting embolic events. These techniques enable healthcare providers to intervene promptly to prevent irreversible neurologic damage and improve patient outcomes. The evolution of neurologic monitoring techniques in aortic arch surgery has been driven by advancements in technology and increased understanding of the pathophysiology of cerebral ischemia. Techniques such as transcranial Doppler (TCD), somatosensory evoked potentials (SSEPs), electroencephalography (EEG), and near-infrared spectroscopy (NIRS) have shown promise in providing valuable information about cerebral perfusion, oxygenation, and electrical activity during surgery.

Evolution of neurologic monitoring techniques

Transcranial Doppler (TCD): TCD is a non-invasive technique that utilizes ultrasound to assess cerebral blood flow velocity in major intracranial vessels. It provides real-time information on cerebral hemodynamics and allows detection of embolic events during surgery. TCD has proven useful in guiding interventions to prevent cerebral ischemia, leading to improved outcomes.

Somatosensory Evoked Potentials (SSEPs): SSEPs measure the electrical responses of the central nervous system to peripheral nerve stimulation. In aortic arch surgery, SSEPs assess the integrity and function of the spinal cord and brainstem. Monitoring changes in SSEPs allows for early detection of ischemic insults and facilitates prompt corrective measures to prevent irreversible neurologic damage [4,5].

Electroencephalography (EEG): EEG records the electrical activity of the brain using scalp electrodes. It provides continuous monitoring of brain function and helps identify subtle changes in cerebral activity during aortic arch surgery. EEG has demonstrated utility in detecting cerebral ischemia, guiding anesthesia management, and predicting neurologic outcomes.

Near-Infrared Spectroscopy (NIRS): NIRS measures regional tissue oxygen saturation by analyzing the absorption of near-infrared light. It enables real-time monitoring of cerebral oxygenation and helps detect cerebral hypoperfusion or embolic events during aortic arch surgery. NIRS has shown promise in guiding interventions to optimize cerebral perfusion and minimize the risk of neurological complications.

Clinical outcomes

The integration of evolving neurologic monitoring techniques into aortic arch surgery has resulted in improved clinical outcomes. Early detection of cerebral ischemia or embolic events allows for prompt interventions such as selective cerebral perfusion, repositioning, or modification of surgical techniques to minimize neurological injury. The use of neurologic monitoring techniques has been associated with reduced rates of perioperative stroke, decreased neurologic morbidity, and improved long-term cognitive function.

Neurologic monitoring techniques continue to evolve in the field of aortic arch surgery, allowing for improved detection and management of cerebral ischemia and neurological complications. Transcranial Doppler, somatosensory evoked potentials, electroencephalography, and near-infrared spectroscopy have demonstrated their utility in guiding surgical strategies and optimizing patient outcomes. Further research and technological advancements in neurologic monitoring are warranted to enhance our understanding and refine these techniques, ultimately leading to better outcomes in aortic arch surgery patients.

Acknowledgement

None.

Conflict of Interest

There are no conflicts of interest by author.

References

1. Horvath, Balazs, Benjamin Kloesel, Michael M. Todd and Daniel J. Cole, et al. "The evolution, current value, and future of the american society of anesthesiologists physical status classification system." Anesthesiology 135 (2021): 904-919.

Google Scholar, Crossref, Indexed at

2. Riley, Richard D., Joie Ensor, Kym IE Snell and Frank E. Harrell, et al. "Calculating the sample size required for developing a clinical prediction model." BMJ 368 (2020).

Google Scholar, Crossref, Indexed at

3. Flores, Glenn. "The impact of medical interpreter services on the quality of health care: A systematic review." Med Care Res Rev 62 (2005): 255-299.

Google Scholar, Crossref, Indexed at

4. Sayegh, Aref S., Michael Eppler, Jorge Ballon and Sij Hemal, et al. "Strategies for improving the standardization of perioperative adverse events in surgery and anesthesiology: The long road from assessment to collection, grading and reporting.” J Clin Med 11 (2022): 5115.

Google Scholar, Crossref, Indexed at

5. Cacciamani, Giovanni E., Tamir Sholklapper, Paolo Dell'Oglio and Bernardo Rocco, et al. "The intraoperative complications assessment and reporting with universal standards (icarus) global surgical collaboration project: Development of criteria for reporting adverse events during surgical procedures and evaluating their impact on the postoperative course." Eur Urol Focus 8 (2022): 1847-1858.

Google Scholar, Crossref, Indexed at