Monitoring during Anesthesia for Vascular Surgery: Update

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) during Open Vascular and Endovascular Surgery.”

1. Perioperative echocardiography has an increasing role as standard haemodynamic monitoring to guide assessment and management during major vascular surgery.
2. 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”

1. NIRS monitoring can provide continuous data on regional oxygenation in patients undergoing vascular surgery.
2. Although NIRS monitoring is generally used to assess regional cerebral oxygenation, there is increasing experience in other settings, such as spinal cord and lower limb ischaemia.

Dr A Tercero “Monitoring of evoked potentials during vascular surgery.”

1. Using EEG and Evoked Potentials during carotid endarterectomy provides good predictors for brain ischaemia, helps in early detection when it is reversible, and guides selective shunting. Evoked potentials are also reliable with recent stroke and can predict subcortical ischaemia.
2. In thoracoabdominal aortic aneurysms:
   • Tc-MEPs detect early spinal cord ischaemia (SCI) and correlate well with postoperative neurological deficits.
   • The usefulness of MEPs for detecting delayed SCI and ICU monitoring is still controversial.
   • SSEP can detect early limb ischaemia. Unilateral changes in peripheral and cortical potentials suggest reversible limb ischaemia.
   • If SSEP deficits appear bilaterally only in cortical areas, the SCI is likely irreversible without immediate intervention.

Dr K Houthoff Khemlani – Monitoring to prevent spinal cord ischaemia (SCI). Updates on CSF drainage

1. SCI is a severe complication of thoracoabdominal aortic surgery.
2. Neurological monitoring (motor and sensory evoked potentials) can detect early SCI.
3. CSF biomarkers are not yet clearly identified for early SCI detection.
4. Prophylactic Cerebrospinal Fluid Drainage (CSFD) in open and endovascular thoracoabdominal aortic surgery reduces perioperative SCI incidence.
5. Institutional CSFD protocols are crucial—aiming for MAP > 65 mmHg and CSF pressure 7–12 mmHg.

Dr S. Howell “Perioperative Monitoring during Vascular Surgery”

1. Monitoring during vascular anaesthesia is essential for patient safety and outcome; guidelines support this.
2. There is increasing “over monitoring”, which may create a false sense of safety.
3. Anaesthesiologists must interpret monitors within clinical context and use sound judgment.

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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 during complex major vascular surgery.
• Receive an update on neurological monitoring during aortic and carotid surgery, including motor and sensory evoked potentials and near-infrared spectroscopy (NIRS).
• Understand 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 collaboration 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