Key result
Transcranial Doppler ultrasonography detected microemboli in 20% to 100% of patients during orthopedic surgery, with no identified association with postoperative cognitive function.
Why the study?
Does intraoperative transcranial Doppler ultrasound detect cerebral microemboli during orthopedic surgery, and do these emboli correlate with postoperative cognitive dysfunction?
Systematic Review
Does intraoperative transcranial Doppler ultrasound detect cerebral microemboli during orthopedic surgery, and do these emboli correlate with postoperative cognitive dysfunction?
While transcranial Doppler ultrasound frequently detects cerebral microemboli during orthopedic surgery, current evidence does not support an association between these microemboli and postoperative cognitive dysfunction.
TCD-detected microemboli lack association with postoperative cognitive dysfunction; does not support routine monitoring for risk stratification and leaves open alternative mechanisms.
Transcranial Doppler ultrasonography has been used to detect microemboli in the middle cerebral artery during orthopedic surgery. We conducted a comprehensive systematic literature review of transcranial Doppler ultrasonography in orthopedic surgery to evaluate its status in this setting. Fourteen studies were selected for qualitative analysis. The highest number of patients studied was 45; emboli were detected in all studies, occurring in 20%-100% of patients. Most embolic counts were below 10, but some high counts were noted. No study reported all the technical parameters of the transcranial Doppler ultrasonography. All studies assessed neurologic status, and 6 studies evaluated cognitive function postoperatively. No study identified an association between postoperative cognitive function and embolic count. Six studies sought the presence of right-to-left shunts.
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Silbert et al. (2013) conducted a systematic review in Orthopedic surgery. Transcranial Doppler ultrasonography was evaluated on Detection of microemboli and postoperative cognitive function. Transcranial Doppler ultrasonography detected microemboli in 20% to 100% of patients during orthopedic surgery, with no identified association with postoperative cognitive function.
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