intraoperative monitoring (in elective neurosurgery) ... neuroanesthesia division anesthesiology...

INTRAOPERATIVE

MONITORING

(in elective neurosurgery)

Dr Nicolás de Riva Neuroanesthesia Division

Anesthesiology Department

Hospital Clinic de Barcelona

2 Honorary Clinical Fellow, 2011

3 Steiner LA at al. Crit Care Med. 2002 Apr;30(4):733-8

4

5

6 2015 = ICM+™ Setting in Elective Neurosurgery Theatre

7

‘How much monitoring time

do we need?’

8 81 y/o, HTN (ref 120/80 mmHg) ➔ Right CPA tumour

9 Sitting surgery ➔ Venous air embolisms (3 episodes)

10 8h surgery = 10h monitoring ➔ No NMBA (acoustic neuroma)

11 8h surgery = 10h monitoring ➔ No NMBA (acoustic neuroma)

12 Left MCA & Right ACA Aneurysm Clipping

13 Left MCA & Right ACA Aneurysm Clipping

14

Using NIRS to calculate COx (‘cerebral oximetry index’) allows the retrospective calculation of the ABPOPT in patients undergoing elective neurosurgeries under general total intravenous anaesthesia (TIVA)

HYPOTHESIS

15

AIMS

1. To describe the possibility to monitor intraoperative CA non-invasively in elective neurosurgery (COx index).

2. To determine the possibility to monitor individual ABPOPT

3. To analyze the relation between ABPOPT and ABPINTRAOP

16

AIMS

4. To analyze differences between ABPBASAL (preop), ABPINTRAOP and ABPOPT

5. To analyze differences between surgeries

(Supratentorial vs Infratentorial vs Vascular vs Spinal)

17

18

19

‘Are we calculating ABPOPT the right way?’

20

‘Are we calculating ABPOPT the right way?’

• Single window

• Multi-flexi window (Leuven)

21 Thanks to Erta Beqiri

22 Thanks to Erta Beqiri

23

24

“One size does not fit all”

SCARTD 2016, Barcelona

25

“One size does not fit all”