The use of venovenous extracorporeal membrane oxygenation is increasing worldwide. These patients often require noncardiac surgery. In the perioperative period, preoperative assessment, patient transport, choice of anesthetic type, drug dosing, patient monitoring, and intraoperative and postoperative management of common patient problems will be impacted. Furthermore, common monitoring techniques will have unique limitations. Importantly, patients on venovenous extracorporeal membrane oxygenation remain subject to hypoxemia, hypercarbia, and acidemia in the perioperative setting despite extracorporeal support. Treatments of these conditions often require both manipulation of extracorporeal membrane oxygenation settings and physiologic interventions. Perioperative management of anticoagulation, as well as thresholds to transfuse blood products, remain highly controversial and must take into account the specific procedure, extracorporeal membrane oxygenation circuit function, and patient comorbidities. We will review the physiologic management of the patient requiring surgery while on venovenous extracorporeal membrane oxygenation.

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Objectives/Hypothesis Visible light spectroscopy (VLS) is the technology behind the Food and Drug Administration–approved TSTAT device that is used to monitor tissue oxygen (StO2) and relative total hemoglobin (rtHb) levels by measuring reflected visible light. The purpose of this novel, pilot study was to determine if VLS is a reliable and valid method of measuring StO2 and rtHb levels in the human thyroarytenoid/lateral cricoarytenoid (TA-LCA) muscle complex, thus providing information about vocal fold muscle physiology. Study Design Pre-test/post-test with mulitple baselines and two conditions. Methods VLS measurements were taken at baseline, during exercise, and following recovery on six subjects using both noncontact channel-port endoscope (endo-probe) and laryngeal electromyography (LEMG) needle-guided techniques. Results The average baseline StO2 was 69% (standard deviation [SD] = 3.6%) for the LEMG-guided probe and was 71.5% (SD = 2.8%) for the endo-probe. During phonation, the StO2 for the LEMG-guided probe dropped to 59% (SD = 7%; P = .04). Mean rtHb measured by the LEMG probe rose from a baseline of 144 µM (SD = 165 µM) to 214 µM (SD = 166 µM, P = .34) during phonation and back to 149 µM (SD = 139 µM, P = .85) after recovery. Mean rtHb as measured using the endo-probe at baseline and after recovery was 104 µM (SD = 30 µM, P = .76). Conclusions VLS can be used to measure changes in StO2 and rtHb levels pre- and postexercise in the human TA-LCA muscle complex.

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