Detection of cerebral arterial gas embolism using regional cerebral oxygen saturation, quantitative electroencephalography, and brain oxygen tension in the swine

R P Weenink; M W Hollmann; M F Stevens; J Kager; T M van Gulik; R A van Hulst

doi:10.1016/j.jneumeth.2014.03.009

Detection of cerebral arterial gas embolism using regional cerebral oxygen saturation, quantitative electroencephalography, and brain oxygen tension in the swine

J Neurosci Methods. 2014 May 15:228:79-85. doi: 10.1016/j.jneumeth.2014.03.009. Epub 2014 Mar 28.

Authors

R P Weenink¹, M W Hollmann², M F Stevens³, J Kager⁴, T M van Gulik⁵, R A van Hulst⁶

Affiliations

¹ Diving Medical Center, Royal Netherlands Navy, PO Box 1000, 1780 CA Den Helder, The Netherlands; Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: r.p.weenink@amc.nl.
² Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.w.hollmann@amc.nl.
³ Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.f.stevens@amc.nl.
⁴ Department of Radiology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: j.kager@amc.nl.
⁵ Department of Surgery, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: t.m.vangulik@amc.nl.
⁶ Diving Medical Center, Royal Netherlands Navy, PO Box 1000, 1780 CA Den Helder, The Netherlands; Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Department of Anaesthesiology, Academic Medical Center, University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: r.a.vanhulst@amc.nl.

PMID: 24680890
DOI: 10.1016/j.jneumeth.2014.03.009

Abstract

Background: Cerebral air emboli occur as a complication of invasive medical procedures. The sensitivity of cerebral monitoring methods for the detection of air emboli is not known. This study investigates the utility of electroencephalography and non-invasively measured cerebral oxygen saturation in the detection of intracerebrovascular air.

New method: In 12 pigs oxygen saturation was continuously measured using transcranial near-infrared spectroscopy and oxygen tension was continuously measured using intraparenchymal probes. Additionally, quantitative electroencephalography and microdialysis were performed. Doses of 0.2, 0.4, 0.8, and 1.6 ml of air were injected into the cerebral arterial vasculature through a catheter.

Results: Oxygen saturation and electroencephalography both reacted almost instantaneously on the air emboli, but were less sensitive than the intraparenchymal oxygen tension. There was reasonable correlation (ρ ranging from 0.417 to 0.898) between oxygen saturation, oxygen tension, electroencephalography and microdialysis values.

Comparison with existing methods: Our study is the first to demonstrate the effects of cerebral air emboli using multimodal monitoring, specifically on oxygen saturation as measured using near-infrared spectroscopy.

Conclusions: Our results show that non-invasively measured oxygen saturation and quantitative electroencephalography can detect the local effects of air emboli on cerebral oxygenation, but with reduced sensitivity as compared to intraparenchymal oxygen tension. Prospective human studies using multimodal monitoring incorporating electroencephalography and oxygen saturation should be performed.

Keywords: Air embolism; Animal models; Brain ischemia; Electroencephalography; Near-infrared spectroscopy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Area Under Curve
Blood Gas Analysis
Brain / blood supply*
Brain / pathology
Cerebrovascular Circulation*
Disease Models, Animal*
Electroencephalography*
Embolism, Air / complications
Embolism, Air / diagnosis*
Female
Intracranial Embolism / complications
Intracranial Embolism / diagnosis*
Intracranial Pressure
Microdialysis
Outcome Assessment, Health Care
Statistics as Topic
Swine