Cerebral oximetry

[stonemd]

I have begun using cerebral oximetry on sitting shoulder cases. At $75 per probe it would be nice to use 1 rather than bilateral probes.

Anyone experienced with
Probe placement - if one probe used should it be lateral or placed over the midline
Side - if probe is placed laterally, which side would you use?
Bilat probes- what would be the reL indications for the use of two probes?

Surprisingly haven't seen any desat yet, though have seen rise with increase in FiO2 and treating hypotension with ephedrine.

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[sevoflurane]

Never used it for a shoulder. Use them in the CT room.
If you are only putting them on one side, you are only monitoring one side. They are affected by a number of variables. I find them useful when there is an acute blood loss event and the patient is down. I like to see the cerebral sats come up with aggressive resuscitation. If they stay down, it's worrisome, but not the be all and end all. I have seen people transfusing based on cerebral sats. This is NOT the way to use this monitor.

Severe bilateral carotid disease in a patient that will be sitting @ 90 degrees might be a good indication for this monitor although I would likely not use it. I'd just keep the BP at or above the resting BP.

 

[Triple AAA]

I have rarely used cerebral Ox probes. The few times I have, they have been bilateral, and they have only been for carotid surgeries and very rarely open hearts.

The truth is, there really isn't a great sensitive or specific monitor to assess global cerebral oxygenation. The Cerebral Ox stickers adhere poorly and slide off half the time, giving spurious readings. I would argue that your best 'monitors' for cerebral oxygenation are your aline and pulse Ox. Follow this with a quick neuro exam on awakening and you should be fine.