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Monitoring Cerebral Oximetry by Near-Infrared Spectroscopy (NIRS) in Anesthesia and Critical Care: Progress and Perspectives

  • Antonio Pisano
  • Diana Di Fraja
  • Concetta Palmieri
Protocol
Part of the Neuromethods book series (NM, volume 150)

Abstract

Noninvasive estimation of cerebral regional oxygen saturation (rScO2) by means of near-infrared spectroscopy (NIRS), first described more than 40 years ago, is currently commonly used as a cerebral and, more generally, hemodynamic monitoring tool in cardiovascular surgery and neonatal intensive care unit, and in recent years is spreading to other clinical settings in which brain injury and cognitive dysfunction are a major concern, such as interventional neuroradiology procedures, noncardiac surgery in the beach chair position or in high-risk (e.g., elderly) patients, cardiac arrest, and mechanical circulatory support. However, there is no agreement among clinicians about the usefulness and reliability of cerebral NIRS monitoring and, accordingly, its use in clinical practice varies widely worldwide. This is primarily due to the substantial lack of evidence showing improved outcomes with NIRS-guided management, combined with some limitations of the methodology such as the differences among the various commercially available devices and the lack of well-defined reference values and of clinically relevant thresholds for desaturations. In this chapter, we discuss the basic principles and the common clinical uses of cerebral oximetry and review the main evidence about the impact of NIRS-guided management on clinically relevant outcomes, in order to analyze the reasons that hinder a wider dissemination of a potentially useful monitoring tool and, accordingly, to outline the possible direction for future research.

Key words

Near-infrared spectroscopy (NIRS) Cerebral oximetry Cardiac surgery Anesthesia Cardiopulmonary bypass (CPB) Monitoring, intraoperative Intraoperative neurophysiological monitoring Postoperative cognitive dysfunction (POCD) Postoperative complications 

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Antonio Pisano
    • 1
  • Diana Di Fraja
    • 1
  • Concetta Palmieri
    • 2
  1. 1.Cardiac Anesthesia and Intensive Care UnitA.O.R.N. “Dei Colli”, Monaldi HospitalNaplesItaly
  2. 2.Department of Anesthesia, Intensive Care and Hyperbaric Medicine“Santobono-Pausilipon” Children’s HospitalNaplesItaly

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