Maintaining Peripheral Circulation in the Surgical Patient: A Narrative Review of the Importance of Near-Infrared Spectroscopy

Since Cushing described heart rate and blood pressure as the variables regularly recorded during surgery, the advancement of devices to record beat-to-beat changes in cardiac stroke volume has provided additional opportunities for perioperative monitoring. While such monitoring focuses on central parameters, as they are derived from the pressure curve, peripheral circulation has received little attention. Secondly, traditional monitoring does not reflect changes in cerebral blood flow, which needs to be considered in frail elderly patients who, due to conditions such as atherosclerosis, are vulnerable to hypotension secondary to impaired cerebral autoregulation. Here, near-infrared spectroscopy, and particularly cerebral oximetry, seem relevant to include in the toolbox for perioperative monitoring. For high-risk surgical patients, it is paramount to assess peripheral circulation during anesthesia. This chapter provides a narrative review of the relevance of the use of NIRS in the perioperative setting.