naa a22 4500 510743706 CHVBK 20180411083037.0 cr unu---uuuuu 180411e20130301xx s 000 0 eng 10.1007/s12630-012-9876-4 doi (NATIONALLICENCE)springer-10.1007/s12630-012-9876-4 Cerebral monitors versus regional anesthesia to detect cerebral ischemia in patients undergoing carotid endarterectomy: a meta-analysis [Elektronische Daten] [Joanne Guay, Sandra Kopp] Comparaison des moniteurs cérébraux et de l'anesthésie régionale pour dépister l'ischémie cérébrale chez les patients subissant une endartériectomie carotidienne: une méta-analyse Purpose: The aim of this meta-analysis is to compare the ability of different types of brain monitoring systems vs clinical monitoring of the brain function to detect cerebral ischemia during cross-clamping of the carotid artery under regional anesthesia. Methods: In May 2012, a search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Ovid MEDLINE® for prospective trials with 20 patients or more where a cerebral monitoring system was compared with clinical brain monitoring during a carotid endarterectomy performed under regional anesthesia. The quality of the study was evaluated with the Cochrane Collaboration's tool. Data were extracted independently by the two investigators. Results: Data could be extracted for 4,664 measurements taken from 29 studies: transcranial Doppler (TCD)=739; cerebral saturation=320; stump pressure=2,549; electroencephalography (EEG)=742; evoked potentials=187; jugular venous saturation=79; and jugular venous lactate=48. The pooled diagnostic odds ratios (DOR) and 95% confidence intervals (CI) were obtained for EEG, TCD, stump pressure, evoked potentials, and cerebral saturation: (DOR 65.3; 95% CI 20.5 to 207.7; I2 [56.8%]); (DOR 58.1; 95% CI 23.0 to 146.3; I2 [24.9%]); (DOR 27.8; 95% CI 13.4 to 57.9; I2 [59.9]); (DOR 17.2; 95% CI 2.4 to 123.9 I2 [69.1]); and (DOR 12.1; 95% CI 3.5 to 41.2; I2 [30.8]), respectively. Sequential testing with stump pressure 25mmHg followed by either TCD or EEG delivered the best post-test probabilities. For EEG, the DOR increases with the number of channels used (P=0.03). Conclusion: A combination of stump pressure and either TCD or EEG appears to deliver the best results for detecting brain ischemia during carotid artery cross-clamping. Electroencephalography should be used with a high number of channels. Canadian Anesthesiologists' Society, 2013 Guay Joanne Department of Anesthesiology, University of Montreal, Montreal, QC, Canada aut Kopp Sandra Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA aut Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/3(2013-03-01), 266-279 0832-610X 60:3<266 2013 60 12630 https://doi.org/10.1007/s12630-012-9876-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12630-012-9876-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Guay Joanne Department of Anesthesiology, University of Montreal, Montreal, QC, Canada aut NATIONALLICENCE 700 1- Kopp Sandra Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, USA aut NATIONALLICENCE 773 0- Canadian Journal of Anesthesia/Journal canadien d'anesthésie Springer-Verlag 60/3(2013-03-01), 266-279 0832-610X 60:3<266 2013 60 12630 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer