Postoperative Central Nervous System Monitoring in Adult Cardiac Surgery
The central nervous system (CNS) has the highest rank of priority in all medical interventions including cardiac surgery. Optimal care of the CNS in postoperative period of cardiac surgery mandates appropriate cerebral monitoring to ensure safe course of postoperative care especially when the patient is not fully awake due to residual anesthetics or ongoing effects of sedatives and analgesics.
Implementing CNS monitoring includes a battery of tests from clinical assessments and scoring systems to sophisticated and high-technology invasive and noninvasive monitors. Though for some of these monitors their use is not a common practice for all patients in cardiac surgery ICU, there is a trend to increase using more objective CNS monitoring in these patients especially when considering the ever-increasing rate of higher-risk patients, especially the aging population on one side and the wondrous developments in microprocessor technology and their widespread use in medicine on the other side.
There are some cardiac surgery patients in whom using even more than one modality is suggested, hence using “multimodal CNS monitoring.” A number of standard guidelines and statements for CNS modalities are nowadays available; some are discussed here in the chapter.
KeywordsRichmond Agitation-Sedation Scale (RASS) Sedation-Agitation Scale (SAS) Ramsay Sedation Scale (Ramsay) Electroencephalography (EEG) including multichannel or uni-channel EEG Electroencephalography (EEG) including traditional EEG qEEG and CCEEG Cerebral oximetry Jugular venous oxygen saturation (SjVO2) Monitoring depth of anesthesia Evoked potentials: somatosensory-evoked potential (SSEP) Motor-evoked potential (MEP) Visual-evoked potential (VEP) Auditory-evoked potential (AEP) Gamma rhythm Beta rhythm Alpha rhythm Theta rhythm Delta rhythm Normal and abnormal EEG EEG spectrogram Bispectral index Cerebral oximetry Near-infrared spectroscopy (NIRS) Jugular venous oxygen saturation (SjvO2) Transcranial Doppler (TCD)
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