The American Journal of Surgery
Volume 197, Issue 1 , Pages 55-63, January 2009

Intraoperative cerebral high-intensity transient signals and postoperative cognitive function: a systematic review

  • Kristin K. Martin, D.O., M.S.

      Affiliations

    • Plaza Medical Center, General Surgery Residency, Fort Worth, TX, USA
    • University of North Texas Health Sciences Center, Fort Worth, TX, USA
    • ,
  • Jeremy B. Wigginton, B.S.

      Affiliations

    • University of Mississippi Medical School, Jackson, MS, USA
    • ,
  • Viken L. Babikian, M.D.

      Affiliations

    • Department of Neurology, VA Boston Healthcare System, Boston, MA, USA
    • Boston University School of Medicine, Boston, MA, USA
    • ,
  • Val E. Pochay

      Affiliations

    • Department of Neurology, VA Boston Healthcare System, Boston, MA, USA
    • ,
  • Michael D. Crittenden, M.D.

      Affiliations

    • Division of Cardiac Surgery, VA Boston Healthcare System, Boston, MA, USA
    • ,
  • James L. Rudolph, M.D., S.M.

      Affiliations

    • Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, JP-182, 150 South Huntington Ave., Boston, MA 02130, USA
    • Harvard Medical School, Boston, MA, USA
    • Corresponding Author InformationCorresponding author. Tel.: +1-857 364-6812; fax: +1-857 364-4544

Received 26 September 2007; received in revised form 6 December 2007 published online 26 August 2008.

Abstract 

Background

Much attention in the literature has focused on the relationship between perioperative microemboli during cardiac and vascular surgery and postoperative cognitive decline. Transcranial Doppler ultrasonography (TCD) has been used to measure high-intensity transient signals (HITS), which represent microemboli during cardiac, vascular, and orthopedic surgery. The purpose of this study was to systematically examine the literature with respect to HITS and postoperative cognitive function.

Methods

Systematic PubMed searches identified articles related to the use of TCD and cognitive function in the surgical setting.

Results

The literature remains largely undecided on the role of HITS and cognitive impairment after surgery, with most studies being underpowered to show a relationship. Although the cognitive effects of HITS may be difficult to detect, subclinical microemboli present potential harm, which may be modifiable.

Conclusions

TCD represents a tool for intraoperative cerebral monitoring to reduce the number of HITS during surgery.

Keywords: Embolism, Transcranial Doppler, Postoperative cognitive dysfunction, Surgery, Cardiac surgery, Carotid endarterectomy, Orthopedic surgery

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 K.K.M. and J.B.W. both contributed significantly and share first authorship.

PII: S0002-9610(08)00381-4

doi:10.1016/j.amjsurg.2007.12.060

The American Journal of Surgery
Volume 197, Issue 1 , Pages 55-63, January 2009

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