• Stephanie Kampf, Patrick Schramm, and Klaus Ulrich Klein.
• aDepartment of Anesthesiology, General Intensive Care and Pain Management, Medical University of Vienna, Austria bDepartment of Anesthesiology, Medical Center of the Johannes Gutenberg-University, Mainz, Germany.
• Curr Opin Anaesthesiol. 2013 Oct 1; 26 (5): 543-8.

Purpose Of ReviewMaintenance of adequate blood flow and oxygen to the brain is one of the principal endpoints of all surgery and anesthesia. During operations in general anesthesia, however, the brain is at particular risk for silent ischemia. Despite this risk, the brain still remains one of the last monitored organs in clincial anesthesiology.Recent FindingsTranscranial Doppler (TCD) sonography and near-infrared spectroscopy (NIRS) experience a revival as these noninvasive technologies help to detect silent cerebral ischemia. TCD allows for quantification of blood flow velocities in basal intracranial arteries. TCD-derived variables such as the pulsatility index might hint toward diminished cognitive reserve or raised intracranial pressure. NIRS allows for assessment of regional cerebral oxygenation. Monitoring should be performed during high-risk surgery for silent cerebral ischemia and special circumstances during critical care medicine. Both techniques allow for the assessment of cerebrovascular autoregulation and individualized management of cerebral hemodynamics.SummaryTCD and NIRS are noninvasive monitors that anesthesiologists apply to tailor cerebral oxygen delivery, aiming to safeguard brain function in the perioperative period.

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