Name of the Procedure:

Electroencephalogram (EEG) during nonintracranial surgery (e.g., carotid surgery)

Summary

An Electroencephalogram (EEG) is a test that measures electrical activity in the brain using small, metal discs (electrodes) attached to the scalp. During nonintracranial surgeries, such as carotid surgery, an EEG monitors the brain's activity to ensure it is functioning properly throughout the operation.

Purpose

The purpose of performing an EEG during nonintracranial surgery is to monitor brain activity in real-time. This helps detect any changes or distress that might indicate a lack of sufficient blood flow or oxygen to the brain, thereby preventing potential damage. The goal is to enhance the safety and outcomes of the surgery by providing immediate feedback to the surgical team.

Indications

• Patients undergoing carotid artery surgery or other procedures where there is a risk of compromised blood flow to the brain.
• Individuals at risk of stroke during surgery.
• Patients with preexisting conditions that affect cerebral circulation.

Preparation

• Patients may need to wash their hair the night before the procedure to remove any oils.
• No fasting is generally required unless specified for surgery.
• Patients should inform their doctor about all medications they are taking; some may need to be paused or adjusted.
• Anesthesia assessments and other preoperative evaluations will be conducted as part of the surgical preparation.

Procedure Description

1. Pre-Surgery: Electrodes are placed on the patient’s scalp, using a conductive gel to enhance signal quality.
2. Start of Surgery: The surgical procedure begins, and the EEG starts recording brain activity.
3. During Surgery: Throughout the operation, continuous EEG monitoring is maintained. The anesthesiologist and surgical team are provided with real-time data.
4. If Issues Detected: Any significant changes in EEG readings may prompt the surgical team to adjust their techniques or manage anesthesia levels.
5. Completion: Once the surgery is complete, the electrodes are removed, and the EEG monitoring is discontinued.

Tools and Equipment: EEG machine, electrodes, conductive gel. Anesthesia: General anesthesia for the surgery, while sedation is tailored to avoid interference with EEG readings.

Duration

The EEG monitoring lasts for the entire duration of the surgery, which can vary but generally takes around 2 to 4 hours.

Setting

The procedure is performed in an operating room within a hospital or surgical center equipped with EEG monitoring facilities.

Personnel

• Surgeons
• Anesthesiologists
• EEG technologists or neurodiagnostic staff
• Nursing staff

Risks and Complications

• Common: Mild skin irritation from electrodes.
• Rare: Misinterpretation of EEG readings, technical malfunctions.
• Management usually involves adjusting the electrodes or equipment.

Benefits

• Enhanced safety and reduced risk of brain injury during surgery.
• Immediate detection of potential issues.
• Improved surgical outcomes.
• Benefits are realized immediately, contributing to better postoperative recovery.

Recovery

• No specific recovery related to the EEG itself.
• Follow standard postoperative recovery instructions for the primary surgical procedure.
• Expect follow-up appointments to monitor overall recovery from surgery.

Alternatives

• Near-Infrared Spectroscopy (NIRS): Another method to monitor cerebral oxygenation.
• Transcranial Doppler (TCD) Ultrasound: Measures blood flow velocity in the brain’s blood vessels.
• Both alternatives have specific applications and limitations compared to EEG.

Patient Experience

• During: No discomfort from the EEG itself but may feel pressure from the electrodes.
• After: No lasting effects from the EEG. Recovery focuses on the surgical procedure, with typical pain management and comfort measures for postoperative care.