Cerebral Oximetry

cardiac surgery cerebral oximetry monitoring oxygenation vascular surgery Sep 19, 2024
Cerebral Oximetry

🧠 Cerebral oximetry is like a pulse oximeter for the brain!

In contrast to the pulse oximeter, it uses a slightly different method called near-infrared spectroscopy (NIRS), and it is actually measuring venous blood. It presents values on the screen that tell you the balance between oxygen consumption and oxygen delivery to the brain.

When is it used?
👉 Cardiac surgery
👉 Carotid artery surgery
👉 Beach chair position

How do you use it?

Once the monitor is applied to the patient (usually the forehead), a baseline value is obtained. During the procedure, a drop in cerebral oxygenation of >20% should trigger the team to work through a few steps:

1️⃣ Check the head position is neutral and ensure ETT ties are not obstructing blood flow.


2️⃣ Optimise brain oxygen delivery:
👉 Cardiac output
👉 Mean arterial pressure
👉 Oxygen saturation
👉 Normalise ETCO2
👉 Rule out anaemia


3️⃣ Optimise brain oxygen consumption:
👉 Ensure adequate depth of anaesthesia
👉 Avoid hyperthermia
👉 Rule out seizures

What are the limitations?
🔺 False positives are common due to extracranial blood interference
🔺 Interference from surgical equipment is common
🔺 It is only monitoring one part of the brain
🔺 It does not offer a cause for desaturation

✅ Build knowledge
✅ Improve safety

Ref: W Tosh, M Patteril, Cerebral oximetry, BJA Education, Volume 16, Issue 12, December 2016, Pages 417–421, https://doi.org/10.1093/bjaed/mkw024

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