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Canadian Journal of Anesthesia 52:79-87 (2005)
© Canadian Anesthesiologists' Society, 2005
Cardiothoracic Anesthesia, Respiration and Airway

Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy

[La spectroscopie cérébrale par infrarouge en cardiochirurgie chez l’adulte : une étude systématique de son efficacité clinique]

Marie-Christine Taillefer, PhD and André Y. Denault, MD FRCPC

From the Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada.

Address correspondence to: Dr. Marie-Christine Taillefer, Department of Anesthesiology, Montreal Heart Institute, Room R-2230, 5000 Belanger Street, Montreal, Quebec H1T 1C8, Canada. Phone: 514-376-3330, ext. 2043; Fax: 514-593-2160; E-mail: Marie-Christine.Taillefer{at}icm-mhi.org

Objectif : Répondre à ces questions : 1) La spectroscopie par infrarouge (SPIR) est-elle efficace pour la détection clinique de la désaturation cérébrale en chirurgie cardiaque? 2) Les résultats sont-ils fondés sur une solide méthodologie des études?

Sources : MEDLINE, Internet et une recherche manuelle jusqu’en février 2004 pour les articles en anglais et en français sur la SPIR.

Constatations principales : Nous avons revu 48 articles, pour un total de 5 931 interventions en cardiochirurgie avec monitorage par la SPIR. Plus de 83 % des patients avaient eu un pontage aortocoronarien. La majorité des études avec monitorage étaient prospectives. Du point de vue clinique, le monitorage avec la SPIR permet de détecter les épisodes de désaturation cérébrale survenus pendant la chirurgie. Cependant, la majorité des études avaient d’importantes limites méthodologiques et un faible niveau de preuve. La validité de la SPIR vs l’oxymétrie du bulbe jugulaire est mise en question, ainsi que sa valeur prédictive à détecter les patients qui vont souffrir de déficits neurologiques postopératoires. Le seul essai randomisé et contrôlé avait des résultats négatifs à cet égard.

Conclusion : L’application clinique de la SPIR en cardiochirurgie comme moniteur cérébral semble intéressante. Cependant, la SPIR doit être étudiée plus rigoureusement si on veut prouver son utilité clinique en chirurgie cardiaque.




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This Article
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