The Use of Preoperative Transcranial Doppler Variables to Predict Which Patients do Not Need a Shunt During Carotid Endarterectomy

AbstractObjectives: to analyse whether preoperative transcranial Doppler (TCD) variables can predict intraoperative shunt requirement. Design and methods: the blood-flow velocity (BFV) in the major basal cerebral arteries was measured preoperatively with TCD, in 178 patients scheduled for CEA. Carotid artery compression and CO2 reactivity tests were also performed. Intraoperative electroencephalography was used to decide whether a shunt was needed. Differences in the probability of shunt requirement between the categories of variables were assessed with crosstabs statistics. Results: preoperative TCD criteria clearly identified a subgroup of 59 patients (33%) who did not require a shunt. In general, these patients appeared to have adequate collateral flow through the anterior communicating artery. In contrast, prediction of the need for a shunt was less reliable. TCD variables could predict the need for a shunt with a probability of only 60%.Conclusions: preoperative TCD can be used to identify patients who do not require a shunt during carotid endarterectomy

Fo-perturbation and Fo/loudness dynamics in voices of normal children, with and without education in singing

Sustained phonations were compared in two groups of children (aged 7-12), one with special artistic voice education and one from a normal school, without voice complaints or problems. The hypothesis of specific (better) biomechanical vocal fold properties in the first group is confronted with the hypothesis of differences solely related to training of voice control. In both groups, Fo-aperiodicity was measured in a sustained phonation at 3 different SPL levels. As a general rule, aperiodicity clearly decreases when the voice becomes louder. Aperiodicity is highly significantly lower, at all SPL-levels, in children with trained singing voices: this implies better mechanical properties of the vocal oscillator. The Fo/SPL relation on a sustained /a:/ does not differ in trained and untrained children's voices: out of singing context, trained children do not spontaneously control the Fo/SPL dynamics differently from untrained children. The higher regularity of vocal fold pulsed is not related to the duration of training

QEEG changes during carotid clamping in carotid endarterectomy:Spectral edge frequency parameters and relative band power parameters

Intraoperative monitoring is needed to identify accurately those patients in need of a shunt during carotid endarterectomy. EEG can be used for this purpose, but there is no consensus on the variables to use. Using a database consisting of 149 EEGs recorded from patients during carotid endarterectomy under isoflurane (n = 61) or propofol (n = 88) anesthesia and who did or did not receive a shunt, the authors investigated which of 16 derivations (common reference, Cz) and 12 parameters (relative and absolute powers and spectral edge frequencies [SEFs]) singly or in combination could best distinguish between the shunt and the nonshunt groups for the two anesthesia regimens. Receiver operating characteristic curves were used to select derivation/parameter combinations for three types of trend computation: (1) values of relative powers and SEFs during clamping (C) only, (2) clamp minus preclamp (baseline) differences (C-B), and (3) C-B differences in absolute logarithmic power (Delta logP). For both anesthesia regimens, C-B computation distinguished best between the shunt and nonshunt groups. For isoflurane anesthesia, SEF parameters were the best, and for propofol anesthesia the relative power parameters. Discriminant analysis, in which additional derivation/parameter combinations were added, increased the discriminative power of the Delta logP computation but not of the C or C-B computations. For isoflurane anesthesia, SEF 90% was the best single parameter for distinguishing between patients who did and did not need a shunt and the four best derivations were F3-Cz, P4-Cz, C4-Cz, and F7-Cz. For the propofol anesthesia, the relative power (C or C-B computations) of the delta band was the best and the four best derivations were F8-Cz, T4-Cz, C4-Cz, and F4-Cz