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Quick Reference: Cerebral Oximetry with Near-Infrared Spectroscopy (NIRS)

NIRS provides a noninvasive measure of local tissue perfusion that can be used during non-pulsatile flow conditions such as cardiopulmonary bypass (CPB) or cardiac arrest. In recent randomized trials, cerebral oximetry monitoring has been associated with shorter recovery room and hospital stay in non-cardiac surgery and with a decrease in major organ dysfunction and in intensive care length of stay after cardiac surgery, thus providing rationale for its use.
Cerebral Oximetry Setup:
  1. Ensure proper device-specific pad placement.
  2. The skin should be cleaned with an alcohol wipe before placing the pads. This skin must be dry or the pads will not stick. Avoid placing sensors on hair.
  3. The pads should be placed over the frontal eminences transilluminates cortical brain areas corresponding to the junction between the anterior and middle cerebral artery.
  4. Follow device-specific protocol to establish baseline values. The baseline should be established prior to induction and prior to O2 delivery via facemask.
Perfusion Interventions:
  1. Adjust head position.
  2. Rule out mechanical obstruction.
  3. Check cannula placement.
  4. Check for superior vena cava (SVC) obstruction and adequate venous drainage.
  5. Increase mean arterial pressure (MAP).
  6. Verify systemic oxygenation.
  7. Increase pump flow rate.
  8. Normalize PaCO2.
  9. If Hgb < 7 gm/dL, consider RBC transfusion (one unit at a time).
  10. Check for aortic dissection.
  11. Avoid cerebral hyperthermia during rewarming.
  12. Ensure appropriate depth of anesthesia.

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