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Ann Thorac Surg 1996;61:934
© 1996 The Society of Thoracic Surgeons

Invited Commentary

Invited Commentary

Joel B. Gunter, MD

Department of Anesthesia Children's Hospital Medical Center 3333 Burnet Ave OSB-3 Cincinnati, OH 45229-3039

See also page 930.

A guiding principle of the practice of medicine is primum non nocere: first do no harm. This principle finds expression in ongoing efforts to minimize neurologic injury associated with cardiopulmonary bypass. Ideally, continuous monitoring of neuronal function and metabolism would allow timely intervention to prevent neurologic injury. In the absence of such a continuous, direct monitor, reliance has been placed on nonspecific, global assessments of neurologic function (eg, electroencephalogram) or adequacy of cerebral oxygen delivery (eg, jugular venous bulb oxygen saturation), or, as often as not, no monitoring of cerebral function at all.

Daubeney and associates advance monitoring of cerebral oxygenation by demonstrating high correlation between transcranial near-infrared spectroscopy (NIRS) and jugular venous bulb oximetry. Although both techniques are surrogate measures, in that neither directly measures neuronal function or oxygenation, NIRS has the advantages of being noninvasive, continuous, and applicable during deep hypothermic circulatory arrest. More importantly, NIRS using additional wavelengths of infrared light is capable of measuring the state of oxygenation of intracellular cytochrome aa3 as well as that of intravascular hemoglobin; thus, NIRS has the potential to both directly monitor cellular neuronal oxygenation and assess adequacy of cerebral oxygen delivery. Although NIRS requires additional development and clinical validation, it has the potential to revolutionize assessment of cerebral oxygenation in the same way that pulse oximetry revolutionized assessment of arterial saturation. Indeed, continuous direct monitoring of cerebral oxygenation by NIRS may eventually become as commonplace as monitoring of arterial oxygen saturation is today.

Footnotes

Address reprint requests to Dr Webber, Division of Cardiology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue at De Soto St, Pittsburgh, PA 15213.


Related Article

Cerebral Oxygenation Measured by Near-Infrared Spectroscopy: Comparison With Jugular Bulb Oximetry
Piers E. F. Daubeney, Sally N. Pilkington, Ellen Janke, Gareth A. Charlton, David C. Smith, and Steven A. Webber
Ann. Thorac. Surg. 1996 61: 930-934. [Abstract] [Full Text]




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