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The role of somatosensory evoked potentials in detecting cerebral ischaemia during carotid endarterectomy

An assessment of its validity under regional anaesthesia

Published online by Cambridge University Press:  01 August 2008

S. Fielmuth  and
T. Uhlig
S. Fielmuth*
Affiliation:
Washington University School of Medicine, Department of Anesthesiology, St. Louis, MO, USA Dietrich-Bonhoeffer-Klinikum, Klinik für Anästhesiologie und Intensivmedizin, Klinikum Neubrandenburg, Germany
T. Uhlig
Affiliation:
Karl-Franzens-Universität Graz, Austria Klinikum Luedenscheid, Zentrum fuer Anaesthesie und Intensivmedizin, Germany
*
Department of Anesthesiology, Washington University School of Medicine, Box 8054, 660 S. Euclid, St. Louis, MO 63110, USA. E-mail: fielmuts@msnotes.wustl.edu; Tel: +314 362 1355; Fax: +314 747 1070
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Summary

Background and objective

The generation of shunt criteria by somatosensory evoked potentials is controversial. This study was designed to validate somatosensory evoked potentials’ tracings and their derived shunt criteria compared with clinical-neurological examination.

Methods

We prospectively studied the somatosensory evoked potentials’ tracing in 102 patients who underwent carotid endarterectomy under cervical plexus blockade, comparing different somatosensory evoked potentials’ derived thresholds of impaired cerebral blood flow with the neurological examination.

Results

The 50% reduction of the primary cortical response to median nerve stimulation as threshold of critical cerebral blood flow showed a sensitivity of 87% and a specificity of 66%. In case of total collapse of primary cortical response, we observed a sensitivity of 85% and a specificity of 89%. Concerning the prolongation of central conduction time between the spinal response at N13 and the cortical response at N20/P25 as critical threshold of impaired cerebral blood flow, the sensitivity was 87% and specificity 40%. The need-to-shunt index with its threshold at >0.5 showed a sensitivity of 85% and a specificity of 88%.

Conclusion

Compared to other studies, we have shown a much lower sensitivity and specificity of somatosensory evoked potentials in detecting critical cerebral perfusion; thus its use remains controversial and has to be assessed in further investigations.

Keywords

SOMATOSENSORY EVOKED POTENTIALSCAROTID STENOSISCERVICAL PLEXUSANAESTHESIA CONDUCTIONSURGERY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 25 , Issue 8 , August 2008 , pp. 648 - 656
Copyright
Copyright © European Society of Anaesthesiology 2008

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