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A retrospective study of changes in cerebral oxygenation using a cerebral oximeter in older patients undergoing prolonged major abdominal surgery

Published online by Cambridge University Press:  01 March 2007

D. W. Green
D. W. Green
Affiliation:
King's College Hospital NHS Trust, Intensive Care and Pain Relief, Department of Anaesthetics, Denmark Hill, London, UK
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Summary

Background and objective

The objective was to carry out a retrospective study of changes in regional cerebral oxygen saturation (rSO2) using the Somanetics Invos Cerebral Oximeter (SICO) in older patients undergoing prolonged major abdominal surgery. Since evidence is accumulating that detection and correction of falls in rSO2 may be associated with a reduced incidence of postoperative cognitive dysfunction, the study assessed the incidence and possible predisposing factors for significant falls in rSO2 and strategies for correction.

Methods

Data from 46 consecutive patients aged 55 yr or above undergoing major abdominal surgery were collected and studied. A SICO electrode was placed over the right forehead prior to commencement of anaesthesia and values of rSO2 were recorded automatically on a floppy disk at 20 s intervals throughout the procedure and until transfer of the patient to the postanaesthesia care unit. Anaesthesia and physiological data were routinely collected by the author on an anaesthetic record computer and transferred to an Excel spreadsheet for analysis.

Results

Average duration of the surgery exceeded 7 h. Average blood loss was 1363 mL (interquartile range 500–2000). In 11 of the 46 patients the rSO2 drop exceeded 20%, and in six, there was a significant temporal association of rSO2 drop with ongoing major haemorrhage. In 23 of the 46 patients, a maximum drop in rSO2 occurred, which was about 15% or more. Fall in rSO2 in the 46 patients significantly correlated with blood loss (P < 0.05) and percentage fall in haemoglobin (Hb) (P = 0.01) but not with lowest Hb. Despite maintenance of conventional haemodynamic parameters such as systolic blood pressure (BP) in most patients, the fall in rSO2 seemed only reversible by blood transfusion. In five of the six patients who experienced the greatest decline in rSO2 during haemorrhage, there was no correlation between fall in rSO2 and systolic BP.

Conclusions

This retrospective study confirms that a significant reduction in rSO2 is a common accompaniment to prolonged major abdominal surgery in elderly patients, especially if associated with blood loss, and is correctable by blood transfusion. In most cases, these changes would have gone unnoticed with conventional monitoring.

Keywords

BRAIN ISCHAEMIACEREBROVASCULAR CIRCULATIONULTRASONOGRAPHYDOPPLERTRANSCRANIALANAESTHESIA GENERALPOSTOPERATIVE PERIOD, cognitive function
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 3 , March 2007 , pp. 230 - 234
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Moller, JT, Cluitmans, P, Rasmussen, LS et al. . Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998; 351: 857–861.CrossRefGoogle Scholar
2.Abildstrom, H, Rasmussen, LS, Rentowl, P et al. . Cognitive dysfunction 1–2 years after non-cardiac surgery in the elderly. ISPOCD group. International Study of Post-Operative Cognitive Dysfunction. Acta Anaesthesiol Scand 2000; 44: 1246–1251.CrossRefGoogle Scholar
3.Casati, A, Fanelli, G, Pietropaoli, P et al. . Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth Analg 2005; 101: 740–747.CrossRefGoogle ScholarPubMed
4.JrEdmonds, HL, Ganzel, BL, IIIAustin, EH. Cerebral oximetry for cardiac and vascular surgery. Semin Cardiothorac Vasc Anesth 2004; 8: 147–166.CrossRefGoogle ScholarPubMed
5.Plachky, J, Hofer, S, Volkmann, M et al. . Regional cerebral oxygen saturation is a sensitive marker of cerebral hypoperfusion during orthotopic liver transplantation. Anesth Analg 2004; 99: 344–349.CrossRefGoogle ScholarPubMed
6.Samra, SK, Dy, EA, Welch, K et al. . Evaluation of a cerebral oximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology 2000; 93: 964–970.CrossRefGoogle ScholarPubMed
7.JrEdmonds, HL. Multi-modality neurophysiologic monitoring for cardiac surgery. Heart Surg Forum 2002; 5: 225–228.Google ScholarPubMed
8.Taillefer, MC, Denault, AY. Cerebral near-infrared spectroscopy in adult heart surgery: systematic review of its clinical efficacy [[La spectroscopie cerebrale par infrarouge en cardiochirurgie chez l’adulte: une etude systematique de son efficacite clinique]. Can J Anaesth 2005; 52: 79–87.CrossRefGoogle Scholar
9.Lassnigg, A, Hiesmayr, M, Keznickl, P et al. . Cerebral oxygenation during cardiopulmonary bypass measured by near-infrared spectroscopy: effects of hemodilution, temperature, and flow. J Cardiothorac Vasc Anesth 1999; 13: 544–548.CrossRefGoogle ScholarPubMed
10.Yoshitani, K, Kawaguchi, M, Iwata, M et al. . Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia. Br J Anaesth 2005; 94: 341–346.CrossRefGoogle ScholarPubMed
11.Torella, F, McCollum, CN. Regional haemoglobin oxygen saturation during surgical haemorrhage. Minerva Med 2004; 95: 461–467.Google ScholarPubMed
12.Torella, F, Cowley, R, Thorniley, MS, McCollum, CN. Monitoring blood loss with near infrared spectroscopy. Comp Biochem Physiol A Mol Integr Physiol 2002; 132: 199–203.CrossRefGoogle ScholarPubMed
13.Torella, F, Cowley, RD, Thorniley, MS, McCollum, CN. Regional tissue oxygenation during hemorrhage: can near infrared spectroscopy be used to monitor blood loss? Shock 2002; 18: 440–444.CrossRefGoogle ScholarPubMed
14.Torella, F, Haynes, SL, McCollum, CN. Cerebral and peripheral near-infrared spectroscopy: an alternative transfusion trigger? Vox Sang 2002; 83: 254–257.CrossRefGoogle ScholarPubMed
15.Torella, F, Haynes, SL, McCollum, CN. Cerebral and peripheral oxygen saturation during red cell transfusion. J Surg Res 2003; 110: 217–221.CrossRefGoogle ScholarPubMed
16.Spahn, DR, Madjdpour, C. Physiologic transfusion triggers: do we have to use (our) brain? Anesthesiology 2006; 104: 905–906.CrossRefGoogle ScholarPubMed
17.Weiskopf, RB, Feiner, J, Hopf, H et al. . Fresh blood and aged stored blood are equally efficacious in immediately reversing anemia-induced brain oxygenation deficits in humans. Anesthesiology 2006; 104: 911–920.CrossRefGoogle ScholarPubMed
18.Han, SH, Ham, BM, Oh, YS et al. . The effect of acute normovolemic haemodilution on cerebral oxygenation. Int J Clin Pract 2004; 58: 903–906.CrossRefGoogle ScholarPubMed
19.Shehata, N, Wilson, K, Mazer, CD et al. . Factors affecting perioperative transfusion decisions in patients with coronary artery disease undergoing coronary artery bypass surgery. Anesthesiology 2006; 105: 19–27.CrossRefGoogle ScholarPubMed