Advanced neurologic monitoring for cardiac surgery.

Cardiac surgery (CS) with cardiopulmonary bypass (CPB) is currently the most common surgery in the United States. Understanding, avoiding, and preventing postoperative complications, including neurologic deficits following CS, represents a great public and economic benefit for society, especially considering our aging population. There is a critical need to identify new strategies that will prevent harmful events during and after CS. At present, experience with neurophysiologic techniques includes the ability to measure cerebral blood flow velocity/emboli and regional cerebral venous oxygen saturation by transcranial Doppler ultrasound, and by near-infrared spectroscopy, respectively. Continuous monitoring of these variables along with systemic hemodynamics will provide a better understanding of mechanisms of brain and other organ injury during CPB. Neuroprotective interventions based on multimodality neurologic monitoring would ideally eliminate postoperative complications and improve patient outcomes.