ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Rosendo A. Rodriguez
Garry Cornel
Nihal A. Weerasena
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Rodriguez, R. A.
Right arrow Articles by Splinter, W. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Rodriguez, R. A.
Right arrow Articles by Splinter, W. M.

Ann Thorac Surg 1998;66:1862
© 1998 The Society of Thoracic Surgeons

Correspondence

Reply

Rosendo A. Rodriguez, MD, PhDa, Garry Cornel, FRCS(C)a, Nihal A. Weerasena, FRCS(CTh)a, William M. Splinter, MDa

a Division of Cardiovascular Surgery and Department of Anesthesia, Children’s Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, Ont, K1H 8L1, Canada

To the Editor

We have read with great interest the comments by Dr Moro and colleagues regarding their experience using brain monitoring in the detection of compromised cerebral perfusion during venous cannulation. In their case of superior vena caval (SVC) obstruction, the remarkable association between persistent alterations in the cerebral oxygenation detected by near-infrared spectrophotometry and stroke after operation supports the predictive value of this indicator for postoperative organ function [1]. Although our experience with near-infrared spectrophotometry has been with a different device (INVOS 3100; Somanetics, Troy, MI), our multimodal approach (electroencephalogram, transcranial Doppler, and near-infrared spectrophotometry) has been helpful for evaluating the clinical significance of those intraoperative changes [2, 3].

Based on these combined experiences, it appears that SVC obstruction during venous cannulation or excessive manipulation of the heart during lateral exposure of coronary arteries is not a rare event, and that brain monitoring helps to detect cerebral dysfunction during this complication. In addition, we agree with the concept that when central venous pressure catheters are not functional, brain monitoring can provide important information regarding SVC obstruction during cardiopulmonary bypass. We recently treated a 2-year-old child (12 kg) who underwent mitral valve replacement. The central venous pressure catheter placed via the external jugular vein showed minimal elevation at the initiation of bypass. Persistent SVC obstruction by the cannula (16F; Stockert; Sorin, Toronto, Ont, Canada) was detected by brain monitoring during cardiopulmonary bypass. In this situation, neuromonitoring was critical in guiding the manipulation of the SVC cannula for improving cerebral venous drainage. After correction of the SVC cannula placement, the physiologic indicators recovered.

Undetected SVC obstruction after cannulation is a strong risk factor for permanent brain damage. Shorter episodes of compromised cerebral perfusion could produce effects that would be detectable only by detailed cognitive testing [4]. Thus, the measures designed to reduce the effects of a compromised venous return diminish the risk of cumulative brain injury. In this situation, brain monitoring offers a noninvasive method to evaluate the cerebral effects of surgical manipulations.

References

  1. Nollert G., Möhnle P., Tassani-Prell P., Reichart B. Determinants of cerebral oxygenation during cardiac surgery. Circulation 1995;92(Suppl 2):327-333.[Abstract/Free Full Text]
  2. Edmonds H.L., Jr, Rodriguez R.A., Audenaert S.M., Austin E.H., III, Pollock S.B., Ganzel B.L. The role of neuromonitoring in cardiovascular surgery. J Cardiothorac Vasc Anesth 1996;10:15-23.[Medline]
  3. Rodriguez R.A., Splinter W.M., Cornel G., Roberts D., Reid C. Effects of aorto-venous cannulation for cardiopulmonary bypass (CPB) on cerebral blood flow velocities (CBFV) and electroencephalogram (EEG) in children. Anesth Analg 1997;84:S126.
  4. Prough D.S., Zornow M.H. Global cerebral ischemia in humans: how long is too long?. Crit Care Med 1997;25:1776-1777.[Medline]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Rosendo A. Rodriguez
Garry Cornel
Nihal A. Weerasena
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Rodriguez, R. A.
Right arrow Articles by Splinter, W. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Rodriguez, R. A.
Right arrow Articles by Splinter, W. M.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS