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Neuromonitoring & Brain Protection

Content Type: Protocols | Provider

Created: September 30, 2023
Contributors: Patrick Farrer MSN RN • Corey Hammac MSN APRN AGACNP-BC
Editors: Cheryl Crisafi MSN RN CNL • Amanda Rea DNP CRNP AGACNP-BC CCRN CMC CSC E-AEC • Gina McConnell RN BSN CCRN • Shannon Crotwell RN BSN CCRN • Alexander Gregory MD FRCPC •
Sponsor

Overview

Decreased cerebral blood flow during cardiac surgery is associated with a range of adverse outcomes, including delirium, stroke, prolonged hospitalization, cognitive impairment, and mortality. These risks underscore the importance of intraoperative neuromonitoring to detect desaturations early, maintain adequate perfusion, and support neurologic recovery.

Tissue oximetry and EEG-based brain monitoring can play a critical role in guiding perfusion strategies, anesthesia depth, and surgical decision-making. This page outlines current evidence, applications, and clinical considerations for neuromonitoring and brain protection in cardiac surgery.

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AI Assistance Statement

This summary was developed with assistance from artificial intelligence and reviewed, edited, and approved by the listed editor(s). Reference: OpenAI (2025). ChatGPT (November version) [Large language model]. 
https://chat.openai.com

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It is not intended to describe, recommend, or suggest any specific medical practice or intervention, nor should it be considered formal medical advice or consultation. The ERAS Cardiac Society cannot guarantee that the information provided is accurate or complete in every respect. Therefore, the Society is not responsible for any errors, omissions, or clinical outcomes resulting from application of the information obtained through the VEC.

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References

  1. Zorrilla-Vaca A, Healy R, Grant MC, Joshi B, Rivera-Lara L, Brown C, et al. Intraoperative cerebral oximetry-based management for optimizing perioperative outcomes: a meta-analysis of randomized controlled trials. Can J Anaesth J Can Anesth. 2018;65(5):529–42.
  2. Colak Z, Borojevic M, Bogovic A, Ivancan V, Biocina B, Majeric-Kogler V. Influence of intraoperative cerebral oximetry monitoring on neurocognitive function after coronary artery bypass surgery: a randomized, prospective study. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-Thorac Surg. 2015 Mar;47(3):447–54.
  3. Vretzakis G, Georgopoulou S, Stamoulis K, Tassoudis V, Mikroulis D, Giannoukas A, et al. Monitoring of brain oxygen saturation (INVOS) in a protocol to direct blood transfusions during cardiac surgery: a prospective randomized clinical trial. J Cardiothorac Surg. 2013 Jun 7;8:145.
  4. Kara I, Erkin A, Saclı H, Demirtas M, Percin B, Diler MS, et al. The Effects of Near-Infrared Spectroscopy on the Neurocognitive Functions in the Patients Undergoing Coronary Artery Bypass Grafting with Asymptomatic Carotid Artery Disease: A Randomized Prospective Study. Ann Thorac Cardiovasc Surg Off J Assoc Thorac Cardiovasc Surg Asia. 2015;21(6):544–50.
  5. Rogers CA, Stoica S, Ellis L, Stokes EA, Wordsworth S, Dabner L, et al. Randomized trial of near-infrared spectroscopy for personalized optimization of cerebral tissue oxygenation during cardiac surgery. Br J Anaesth. 2017 Sep 1;119(3):384–93.
  6. Uysal S, Lin H-M, Trinh M, Park CH, Reich DL. Optimizing cerebral oxygenation in cardiac surgery: A randomized controlled trial examining neurocognitive and perioperative outcomes. J Thorac Cardiovasc Surg. 2019 Mar 29
  7. Deschamps A, Hall R, Grocott H, Mazer CD, Choi PT, Turgeon AF, et al. Cerebral Oximetry Monitoring to Maintain Normal Cerebral Oxygen Saturation during High-risk Cardiac Surgery: A Randomized Controlled Feasibility Trial. Anesthesiology. 2016 Apr;124(4):826–36.
  8. Kertai MD, Pal N, Palanca BJA, Lin N, Searleman SA, Zhang L, et al. Association of perioperative risk factors and cumulative duration of low bispectral index with intermediate-term mortality after cardiac surgery in the B-Unaware Trial. Anesthesiology. 2010 May;112(5):1116–27.
  9. Vance JL, Shanks AM, Woodrum DT. Intraoperative bispectral index monitoring and time to extubation after cardiac surgery: secondary analysis of a randomized controlled trial. BMC Anesthesiol. 2014;14:79.
  10. Villafranca A, Thomson IA, Grocott HP, Avidan MS, Kahn S, Jacobsohn E. The impact of bispectral index versus end-tidal anesthetic concentration-guided anesthesia on time to tracheal extubation in fast-track cardiac surgery. Anesth Analg. 2013 Mar;116(3):541–8.
  11. Vretzakis G, Ferdi E, Argiriadou H, Papaziogas B, Mikroulis D, Lazarides M, et al. Influence of bispectral index monitoring on decision making during cardiac anesthesia. J Clin Anesth. 2005 Nov;17(7):509–16.