Review of transcranial Doppler ultrasound to detect microemboli during orthopedic surgery

B S Silbert; L A Evered; D A Scott; S Rahardja; R P Gerraty; P F Choong

doi:10.3174/ajnr.A3688

Review of transcranial Doppler ultrasound to detect microemboli during orthopedic surgery

AJNR Am J Neuroradiol. 2014 Oct;35(10):1858-63. doi: 10.3174/ajnr.A3688. Epub 2013 Aug 22.

Authors

B S Silbert¹, L A Evered², D A Scott², S Rahardja³, R P Gerraty⁴, P F Choong⁵

Affiliations

¹ From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia Department of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School brendan.silbert@svhm.org.au.
² From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia Department of Anaesthesia (B.S.S., L.A.E., D.A.S.), Perioperative and Pain Medicine Unit, Melbourne Medical School.
³ From the Department of Anaesthesia (B.S.S., L.A.E., D.A.S., S.R.), Centre for Anaesthesia and Cognitive Function, St. Vincent's Hospital, Melbourne, Australia.
⁴ Epworth Healthcare (R.P.G.), Richmond, Victoria, Australia Department of Medicine (R.P.G.), Epworth HealthCare, Monash University, Melbourne, Australia.
⁵ Department of Surgery (P.F.C.), University of Melbourne, Melbourne, Australia.

Abstract

Transcranial Doppler ultrasonography has been used to detect microemboli in the middle cerebral artery during orthopedic surgery. We conducted a comprehensive systematic literature review of transcranial Doppler ultrasonography in orthopedic surgery to evaluate its status in this setting. Fourteen studies were selected for qualitative analysis. The highest number of patients studied was 45; emboli were detected in all studies, occurring in 20%-100% of patients. Most embolic counts were below 10, but some high counts were noted. No study reported all the technical parameters of the transcranial Doppler ultrasonography. All studies assessed neurologic status, and 6 studies evaluated cognitive function postoperatively. No study identified an association between postoperative cognitive function and embolic count. Six studies sought the presence of right-to-left shunts.

Publication types

Review
Systematic Review

MeSH terms

Female
Humans
Intracranial Embolism / diagnostic imaging*
Male
Middle Aged
Middle Cerebral Artery / diagnostic imaging*
Orthopedic Procedures / adverse effects*
Orthopedics
Ultrasonography, Doppler, Transcranial / methods*