Take-Home Message
Dr. Purificación Matute, MD, PhD
Consultant, Department of Anaesthesia
Hospital Clínic & University of Barcelona
Barcelona
Spain
Professor M. Meineri “Usefulness of Echocardiography (TTE and TOE) use during Open Vascular and Endovascular surgery. “
- Perioperative echocardiography has an increasing role as standard haemodynamic monitoring to guide assessment and management during major vascular surgery.
- The body of evidence supporting the use of perioperative echocardiography during open and endovascular procedures is still scattered.
Dr M. Giménez “NIRS monitoring during vascular surgery”
- NIRS monitoring can provide continuous data on the regional oxygenation in patients undergoing vascular surgery.
- Although NIRS monitoring is generally used to assess regional cerebral oxygenation, there is an increasing usage experience in other settings, such as a study of the spinal cord and lower limb ischaemia.
Dr A Tercero “Monitoring of evoked potentials during Vascular surgery.”
- Using EEG and Evoked Potentials during carotid endarterectomy provide good predictors for brain ischaemia, helps in early detection when it is still reversible and guides to the place of selective shunting. Evoked potentials are also reliable if there is a recent stroke and can work as a consistent predictor of subcortical ischaemia.
- In thoracoabdominal aortic aneurysms.
- Tc-MEPs detect early spinal cord ischaemia (SCI) and shows a good correlation with postoperative neurological deficits.
- The usefulness of MEPs for detecting the DELAYED SCI and ICU monitoring is still controversial.
- SSEP can detect early limb ischaemia If SSEP changes are reported unilaterally in the peripheral and cortical potentials, which means the limb ischaemia can be reversible.
- IF SSEP deficit is detected bilaterally only in the cortical area, that means the SCI is likely to be irreversible if there is no immediate intervention to compete with.
Dr K Houthoff Khemlani “Monitoring to prevent spinal cord ischaemia (SCI). Updates on CSF drainage
- SCI is a severe complication of thoracoabdominal aortic surgery.
- Neurological monitoring with Potential Evoked monitoring (motor and sensitive) can detect early SCI.
- CSF biomarkers are still not clearly identified for early detection of SCI.
- Prophylactic placement of Cerebrospinal fluid drainage (CSFD) in open and endovascular thoracoabdominal aortic surgery decreases the incidence of intraoperative and postoperative SCI.
- It is crucial to develop an institutional protocol for CSFD in patients with a high risk of SCI, considering keeping a MAP > 65 mmHg and CSF pressure of 7-12 mmHg.
Dr S. Howell “Perioperative Monitoring during Vascular Surgery”
- Monitoring during vascular anaesthesia is essential for patients’ safety and reasonable outcome. The different guidelines support that.
- Nowadays, there is an increase in “over monitoring” (including excessive alarms) that sometimes creates a” false feeling of safety”.
- The anaesthesiologists should use the monitors in an adequate clinical context and consider their common sense.
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What’s in it for me?
After participating in this webinar, you will better understand:
- Acquire experience on the usefulness of transthoracic and transoesophageal echocardiography use during complex major vascular surgery;
- Have an update on neurological monitoring during aortic and carotid surgery, including motor and sensory evoked potentials and near-infrared spectroscopy (NIRS);
- Understand the strategies to protect against spinal cord ischaemia during aortic surgery focusing on cerebrospinal fluid drainage;
- Better define indications, contraindications and complications associated with cerebrospinal fluid drainage in major vascular procedures.
The EACTAIC Education Committee organised this webinar in colloboaration with the EACTAIC Vascular Subspeciality Committee.
Target audience
Vascular surgeons, vascular anaesthetists, perfusionists, intensivists, general anaesthetists, anaesthesia certified nurses, nurses, interns, and medical students.
Scientific director: Mohamed R. El Tahan, EACTAIC Education chair
