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INTRAOPERATIVE MONITORING (in elective neurosurgery) Dr Nicolás de Riva Neuroanesthesia Division Anesthesiology Department Hospital Clinic de Barcelona

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INTRAOPERATIVE

MONITORING

(in elective neurosurgery)

Dr Nicolás de RivaNeuroanesthesia 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

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6 2015 = ICM+™ Setting in Elective Neurosurgery Theatre

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‘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

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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

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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

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AIMS

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

5. To analyze differences between surgeries

(Supratentorial vs Infratentorial vs Vascular vs Spinal)

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‘Are we calculating ABPOPT

the right way?’

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‘Are we calculating ABPOPT

the right way?’

• Single window

• Multi-flexi window (Leuven)

21 Thanks to Erta Beqiri

22 Thanks to Erta Beqiri

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“One size does not fit all”

SCARTD 2016, Barcelona

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“One size does not fit all”