Razumovsky AY, Jahangiri FR, Balzer J, et al. J Neuroimaging 2022;1–17. https://lnkd.in/eKWNpUMK
A rapidly growing literature shows that essential hemodynamic information provided by transcranial Doppler (TCD) ultrasonography neuromonitoring (TCDNM) provides an effective monitoring modality for improving outcomes after many vascular, neurosurgical, orthopedic, cardiovascular, and cardiothoracic surgeries and for some endovascular interventional or diagnostic procedures, like cardiac catheterization or cerebral angiography.
Understanding and preventing peri- or postoperative complications, including neurological deficits following the above-mentioned surgeries, endovascular interventions, or diagnostic procedures, is of great public benefit, especially considering aging populations. TCDNM provides prompt and instantaneous warning of CBF changes, emboli, hyperperfusion, and hypoperfusion. This knowledge will affect surgical technique, blood pressure and carbon dioxide control, and medical therapy in the operating room (OR) and postoperatively. TCDNM offers surgeons a better understanding of causes of neurological complications and reduces the risk of these events.
Not until 2011, however, did any relevant, recognized professional medical organization provide guidelines or certifications specifically for the unique skills involved in continuous peri-operative or critical care TCDNM to influence patient care instantaneously. In 2011 the Guideline Committees of the American Society of Neurophysiologic Monitoring (ASNM) and the American Society of Neuroimaging (ASN) published practice guidelines for TCDNM in the surgical and intensive care settings. TCDNM may not directly prevent embolic events and postoperative complications but they may be recognized before clinical signs and symptoms occur. When hypoperfusion or hyperperfusion is detected in real time, early therapeutic measures can be instituted to prevent complications.
Now, a decade later, the ASNM and ASN Guidelines Committees formed a joint task force and published these updated guidelines for the use of TCDNM in the surgical and intensive care settings. These guidelines define (1) the objectives of TCD monitoring; (2) the responsibilities and behaviors of the neurosonographer during monitoring; (3) instrumentation and acquisition parameters; (4) safety considerations; (5) contemporary rationales for TCDNM; (6) TCDNM perspectives; and (7) major recommendations. For the neurosonographer these guidelines are indispensable for providing guidance to identify technical issues and to immediately alert the interoperative surgical team to the presence of radiofrequency interference from the immediate or neighboring OR or inadequate probe fixation resulting in an ambiguous, obscured, or evanescent CBFV spectrum.