Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia

Yoshitani, Kenji; Kawaguchi, Masahiko; Iwata, Makoto; Sasaoka, Noriyuki; Inoue, Satoki; Kurumatani, Norio; Furuya, Hitoshi

doi:10.1093/bja/aei046

Cited by 83 publications

(42 citation statements)

References 27 publications

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“…In adults, normal TOI values have been reported to range from 65% to 85%. 14,36 -41 Although a number of authors have compared NIRS with other techniques such as jugular bulb oxygen saturation (SjO 2 ), transcranial Doppler ultrasonography and somatosensory-evoked potential 15,37,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] or with neurologic events, few have attempted to define an absolute threshold for ischemia. 13,14,16,17,46,[57][58][59] Most studies of this type using NIRS make no attempt to correct for extracranial contributions to signal changes.…”

Section: Discussionmentioning

confidence: 99%

Tissue Oxygen Index

Al-Rawi

Kirkpatrick

2006

Stroke

149

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Background and Purpose-To date, the clinical application of near infrared spectroscopy in the adult brain has been limited. The NIRO 300 (Hamamatsu Photonics) provides a continuous measurement of tissue oxygen index (TOI) using spatially resolved spectroscopy. Although TOI reflects cerebral oxygenation to a high degree of sensitivity and specificity, to become a useful clinical tool, thresholds for cerebral ischemia need to be defined. This study has attempted to identify a quantifiable TOI threshold for ischemia in the adult brain. Methods-One hundred sixty-seven patients undergoing carotid endarterectomy were studied. The NIRO 300 was incorporated into an established multimodal monitoring system enabling observations of cerebral hemodynamic changes under highly controlled conditions. Changes in TOI (%⌬TOI) on clamping the internal carotid artery were compared with intracranial blood flow (middle cerebral artery flow velocity) and cerebral function monitoring to identify and quantify periods of cerebral ischemia. Results-Significant correlation was seen between changes in middle cerebral artery flow velocity and ⌬TOI on clamping (rϭ0.74, Pϭ0.0001). Thirty-one patients showed cerebral ischemia on internal carotid artery clamping as defined by a sustained fall in cerebral function monitoring. A threshold for %⌬TOI of Ϫ13 was identified, above which no patients showed any evidence of ischemia on clamping. This threshold provided 100% sensitivity and 93.2% specificity for patients satisfying the preset criteria for cerebral ischemia. Conclusions-These data demonstrate the potential to identify TOI-quantified thresholds for cerebral ischemia in the adult brain and thus improve the clinical use of near infrared spectroscopy. Our observations have defined a drop in TOI (13%) that can be adopted as a threshold for severe cerebral ischemia with high sensitivity and specificity. Key Words: carotid endarterectomy Ⅲ cerebral ischemia Ⅲ near infrared spectroscopy Ⅲ spatially resolved spectroscopy Ⅲ tissue oxygen index O ptical methods based on near-infrared spectroscopy (NIRS) can be used to monitor hemodynamic variables in the clinical setting. 1 Applications include monitors of fetal physiology, 2-4 during cardiac surgery, 5,6 muscle function, 7-10 and neonatal, 11 pediatric, 12 and adult brain. [13][14][15][16][17][18][19] A number of NIRS instruments are now available that detect changes in optical attenuation from several wavelengths of light, and although a variety of algorithms have been applied to attempt quantification, accuracy of these instruments remains a concern.The NIRO 300 (Hamamatsu Photonics) provides a continuous online measurement of tissue oxygen index (TOI) using spatially resolved spectroscopy. 20,21 We have previously determined that TOI reflects cerebral oxygenation to a high degree of sensitivity and specificity during carotid surgery, 20 an indication that NIRS can show clinically relevant estimations of cerebral hemodynamic and oxygen changes in the adult head (Figure 1). However, there are no da...

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Section: Discussionmentioning

confidence: 99%

Tissue Oxygen Index

Al-Rawi

Kirkpatrick

2006

Stroke

149

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“…The mean value of rSO 2 was estimated at 65%, based on previous reports. 16,17 To identify a change in rSO 2 value of more than 5% between the Values are mean ± SD. T 0 , after induction of anaesthesia (baseline); T 1 , 10 min after placing in the Trendelenburg position; T 2 , 30 min after the creation of pneumoperitoneum; T 3 , after completion of surgery (patient still under anaesthesia).…”

Section: Discussionmentioning

confidence: 99%

The Effect of Gynaecological Laparoscopic Surgery on Cerebral Oxygenation

Lee

et al. 2006

J Int Med Res

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During gynaecological laparoscopic surgery, alterations in cerebral blood flow and intracranial pressure are frequently reported. These changes affect cerebral perfusion pressure and thus may affect cerebral oxygenation. In this prospective study, the effect of gynaecological laparoscopic surgery on cerebral oxygenation was examined by following the changes in regional cerebral oxygen saturation (rSO 2 ). Twenty-four female patients were enrolled. The mean rSO 2 was 65.5 ± 5.4% at baseline before surgery, 60.8 ± 5.6% when the patient was placed in the Trendelenburg position, 57.1 ± 9.3% after creation of pneumoperitoneum, and 64.0 ± 7.3% after the completion of surgery. During the period of pneumoperitoneum, rSO 2 fell below 50% in two hypercapnic patients. In comparison with baseline, rSO 2 declined significantly in the Trendelenburg position. The creation of pneumoperitoneum itself did not decrease the average rSO 2 value further unless the patients were hypercapnic.

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“…Positive emission tomography has demonstrated the venous: arterial blood volume ratio, approximating 70 %, to correlate with ScO 2 measurement [103]. However this absolute ratio may vary between individuals [43,104], with hypoxia [105], hemodilution [106] and with changes in PaCO 2 [107 • ]. Importantly head elevation causes a dynamic reduction in cerebral blood volume, with compensatory changes in vascular tone and arterial inflow.…”

Section: Validity Of Sco 2 With Postural Changementioning

confidence: 99%

Effects of Positioning on Cerebral Oxygenation

Soeding

2013

Curr Anesthesiol Rep

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Postural change during anesthesia has a complex effect on the systemic and cerebral circulations which can potentially decrease cerebral blood flow and oxygenation. Cerebral oximetry is emerging as a monitor of cerebral perfusion with widespread application in many types of surgery. The technology is based on the differential absorption of oxygenated and deoxygenated hemoglobin to near-infrared light. However, the dynamic coupling that exists between cerebral arterial, venous and cerebrospinal fluid volumes may influence oximetric readings during postural change. Interpretation of cerebral oxygen saturation measurement must account for these changes in cerebral physiology if monitoring is to predict neurological outcome.

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Comparison of changes in jugular venous bulb oxygen saturation and cerebral oxygen saturation during variations of haemoglobin concentration under propofol and sevoflurane anaesthesia

Cited by 83 publications

References 27 publications

Tissue Oxygen Index

Tissue Oxygen Index

The Effect of Gynaecological Laparoscopic Surgery on Cerebral Oxygenation

Effects of Positioning on Cerebral Oxygenation

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