From the Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts.
Anesth Analg. 2021 Aug 1;133(2):379-392. doi: 10.1213/ANE.0000000000005417.
Transcranial Doppler (TCD) ultrasonography is the only noninvasive bedside technology for the detection and monitoring of cerebral embolism. TCD may identify patients at risk of acute and chronic neurologic injury from gaseous or solid emboli. Importantly, a window of opportunity for intervention-to eliminate the source of the emboli and thereby prevent subsequent development of a clinical or subclinical stroke-may be identified using TCD. In this review, we discuss the application of TCD sonography in the perioperative and intensive care setting in adults and children known to be at increased risk of cerebral embolism. The major challenge for evaluation of emboli, especially in children, is the need to establish the ground truth and define true emboli identified by TCD. This requires the development and validation of a predictive TCD emboli monitoring technique so that appropriately designed clinical studies intended to identify specific modifiable factors and develop potential strategies to reduce pathologic cerebral embolic burden can be performed.
经颅多普勒（TCD）超声检查是唯一一种用于检测和监测脑栓塞的非侵入性床边技术。TCD 可识别出有发生急性和慢性神经损伤风险的患者，这些损伤可能是由气体或固体栓塞引起的。重要的是，TCD 可识别出干预的机会窗口——消除栓塞源，从而预防随后发生临床或亚临床中风。在这篇综述中，我们讨论了 TCD 超声检查在围手术期和重症监护环境中的应用，这些患者已知存在脑栓塞风险增加。评估栓塞的主要挑战，特别是在儿童中，是需要确定真实情况并定义 TCD 识别的真正栓塞。这需要开发和验证一种预测性 TCD 栓塞监测技术，以便能够进行旨在确定特定可修改因素并开发潜在策略以降低病理性脑栓塞负担的特定临床研究。
