• Marcus Thudium, Evgeniya Kornilov, Tobias Hilbert, Mark Coburn, and Christopher Gestrich.
• Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany. marcus.thudium@ukbonn.de.
• Anaesthesist. 2021 Dec 1; 70 (Suppl 1): 687368-73.

BackgroundAortic arch repair for aortic dissection is still associated with a high mortality rate. Providing adequate means of neuromonitoring to guide cerebral hemodynamics is advantageous, especially during selective anterior cerebral perfusion (SACP).ObjectiveWe aimed to investigate an easy multimodal neuromonitoring set-up consisting of processed electroencephalography (EEG), near infrared spectroscopy (NIRS), and transcranial doppler sonography (TCD).Material And MethodsWe collected intraoperative data from six patients undergoing surgery for aortic dissection. In addition to standard hemodynamic monitoring, patients underwent continuous bilateral NIRS, processed EEG with bispectral index (BIS), and intermittent transcranial doppler sonography of the medial cerebral artery (MCA) with a standard B‑mode ultrasound device. Doppler measurements were taken bilaterally before cardiopulmonary bypass (CPB), during CPB, and during SACP at regular intervals.ResultsOf the patients four survived without neurological deficits while two suffered fatal outcomes. Of the survivors two suffered from transient postoperative delirium. Multimodal monitoring led to a change in CPB flow or cannula repositioning in three patients. Left-sided mean flow velocities of the MCA decreased during SACP, as did BIS values.ConclusionMonitoring consisting of BIS, NIRS, and TCD may have an impact on hemodynamic management in aortic arch operations.© 2021. The Author(s).

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