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The impact of induction of general anesthesia and a vascular occlusion test on tissue oxygen saturation derived parameters in high-risk surgical patients.
MedLine Citation:
PMID:  21948067     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Tissue oxygen saturation (StO(2)) assessed using Near Infrared Spectroscopy and its derived parameters during a vascular occlusion test (VOT) can detect microvascular changes in septic shock patients. General anesthesia (GA) impacts microcirculation. Our aim was to study the effects of general anesthesia on StO(2) and StO(2) derived parameters obtained during VOT in patients referred for cardiac surgery. METHODS: We studied 15 patients referred for cardiac surgery before and after induction of GA. Before GA induction, we also studied 15 healthy volunteers (non patients) in order to compare baseline physiological data between patients and healthy subjects. Hemodynamic and microcirculatory (StO(2), ischemic slope, reperfusion slope, and hyperemic response) data were recorded at each step. We used the Inspectra StO(2) system (Hutchinson Inc, MN, USA) with a sensor placed on the thenar eminence. StO(2) values were obtained at baseline and during a VOT. A sphyngomanometer was placed on the forearm above the StO(2) probe and the cuff was then rapidly inflated 30 mmHg above systolic pressure and was maintained inflated until the StO(2) value reached 40%. It was then rapidly deflated. RESULTS: Healthy volunteers had significantly higher reperfusion slope than patients (348 [251-393] vs. 261 [185-279] %/min; P < 0.05). GA induction induced no significant change in StO(2) value compared to baseline (79 [75-85] vs. 80 [76-86]%; P = 0.57). We observed a significant decrease in ischemic slope (from -12 [-16--8] to -8 [-10--6] %/min; P = 0.004) and in reperfusion slope (from 261 [185-279] %/min to 164 [151-222] %/min; P = 0.008) suggesting a decrease in local metabolic rate and a negative impact on reperfusion reserve induced by anesthesia. CONCLUSION: StO(2) derived parameters during a VOT are impacted by GA induction. These parameters may have potential for microcirculation assessment in patients undergoing surgery.
Authors:
Celine Bernet; Olivier Desebbe; Sebastien Bordon; Charlotte Lacroix; Pascal Rosamel; Fadi Farhat; Jean-Jacques Lehot; Maxime Cannesson
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-23
Journal Detail:
Title:  Journal of clinical monitoring and computing     Volume:  -     ISSN:  1573-2614     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9806357     Medline TA:  J Clin Monit Comput     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Hospices Civils de Lyon, Department of Anesthesiology and Intensive Care, Louis Pradel Hospital, Claude Bernard Lyon 1 University, INSERM ERI 22, Lyon, France.
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