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Abstract
A significant EEG change, 40% power attentuation in anesthetic-induced fast activity,
was documented with a tracing record, compressed spectral analysis, and PSA-1 in this
series of 195 patients. Interpretation of the change was simplified by the use of
the compressed spectral analysis or PSA-1. Quantification of the change was aided
by use of the PSA-1, and the graphic output form of this instrument minimized user
error. Also, it provided the needed information to those members of the operative
team not skilled in EEG interpretation. No immediate postoperative deficits were missed
by the monitoring technique. There were no postoperative deficits upon awakening in
the 138 patients without processed EEG change. Shunt placement, depth of anesthesia,
and intraoperative blood pressure levels were accurately guided throughout the operative
procedure by these monitoring techniques.
Accurate documentation of an acute significant change permits prompt treatment for
restoration of necessary collateral flow. The monitoring technique described continuously
provides information for efficacy of treatment. Attention to blood pressure level,
which seems to passively determine cerebral collateral flow during clamping, was a
very important clinically manipulable variable. Manipulation of this variable with
processed EEG control may prove efficacious not only in patients undergoing carotid
procedures but in nonsurgical cases of acute carotid occlusion or middle cerebral
stem occlusion.
Manipulation of identifiable critical variables has a positive impact on the clinical
outcome when continuous monitoring is employed. The detection of hemispheric low flow
in 34 patients during the preclamp, clamp, and postclamp periods suggests that shunting
will not prevent all low flow deficits. Finally, perfection of surgical therapy for
stroke prevention necessitates detection and treatment of hemispheric low flow.
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References
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Article info
Footnotes
☆Presented at the Sixth Annual Meeting of the Southern Association for Vascular Surgery, Marco Island, Fla., Jan. 29–30, 1982.
Identification
Copyright
© 1983 Published by Elsevier Inc.
