The use of cerebral oximetry in surgery: A systematic review and meta-analysis of randomized controlled trials
Document Type
Article
Publication Date
7-1-2022
Abstract
Objective: The evidence on the use of cerebral oximetry during surgery to minimize postoperative neurologic complications remains uncertain in the literature. The present authors aimed to assess the value of cerebral oximetry in the prevention of postoperative cognitive dysfunction, postoperative delirium, and postoperative stroke in adults undergoing surgery. Design: A systematic review and meta-analysis. Setting: The surgery room. Participants: Adult patients (ages >= 18 years) undergoing surgery. Interventions: Cerebral oximetry monitoring. Measurements and Main Results: Databases of Ovid MEDLINE, Ovid EMBASE, and CENTRAL were systematically searched from their inception until December 2020 for randomized controlled trials comparing cerebral oximetry monitoring with either blinded or no cerebral oximetry monitoring in adults undergoing surgery. Observational studies, case reports, and case series were excluded. Seventeen studies (n = 2,120 patients) were included for quantitative meta-analysis. Patients who were randomized to cerebral oximetry monitoring had a lower incidence of postoperative cognitive dysfunction (studies = seven, n = 969, odds ratio OR] 0.23, 95% confidence interval CI] 0.11-0.48, p = 0.0001; evidence = very low). However, no significant differences were observed in the incidence of postoperative delirium (studies = five, n = 716, OR 0.81, 95% CI 0.53-1.25, p = 0.35; evidence = high), and postoperative stroke (studies = seven, n = 1,087, OR 0.72, 95% CI 0.30-1.69, p = 0.45; evidence = moderate). Conclusion: Adult patients with cerebral oximetry monitoring were associated with a significant reduction of postoperative cognitive dysfunction. However, given the low certainty of evidence and substantial heterogeneity, more randomized controlled trials using standardized assessment tools for postoperative cognitive dysfunction and interventions of correcting cerebral desaturation are warranted to improve the certainty of evidence and homogeneity. (C) 2021 Elsevier Inc. All rights reserved.
Keywords
Cerebral oximetry, NIRS monitoring, Surgery, Cognitive dysfunction, Delirium
Divisions
anaesthesiology
Funders
None
Publication Title
Journal of Cardiothoracic and Vascular Anesthesia
Volume
36
Issue
7
Publisher
Elsevier
Publisher Location
1600 JOHN F KENNEDY BOULEVARD, STE 1800, PHILADELPHIA, PA 19103-2899 USA