Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry

doi:10.1093/bja/aen275

BJA Advance Access originally published online on October 3, 2008
British Journal of Anaesthesia 2008 101(6):870-875; doi:10.1093/bja/aen275

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Significant decrease of cerebral oxygen saturation during single-lung ventilation measured using absolute oximetry

T. M. Hemmerling¹^,2^,*, M. C. Bluteau¹, R. Kazan¹ and D. Bracco¹

¹ Department of Anaesthesiology, ITAG (Intelligent Technology in Anaesthesia Group), Montreal General Hospital, McGill University, 1650 Cedar Avenue, Montreal, Canada H3G 1B7
² Institute of Biomedical Engineering, University of Montreal, Montreal, Canada

^* Corresponding author. E-mail: thomashemmerling{at}hotmail.com

Background: Single-lung ventilation (SLV) during thoracic surgery causesimportant cardiopulmonary disturbances. Absolute cerebral oximetrywas used to determine the incidence and magnitude of the decreasein cerebral oxygen saturation (Sct_O₂) in patients undergoingSLV during thoracic surgery.

Methods: Data were obtained from 20 consecutive patients undergoing thoracicsurgery and necessitating SLV of more than 1 h. The FORESIGHT^TM(CASMED, USA) absolute oximeter was used to measure left, right,and average absolute Sct_O₂ every 5 min from the awake stateto extubation. Bispectral index and standard monitoring parameterswere also recorded every 5 min. Blood gas analysis was performedevery 15 min. Data median (IQR) (range) were analysed usingrepeated-measures ANOVA and Spearman’s correlation test,P<0.05.

Results: Patients [median age 65 yr (range 46–75)] showed an absoluteSct_O₂ of 80% (78, 82) (74–87) in the awake state, whichdecreased to a minimum Sct_O₂ value of 63% (57, 65) (53–73)during SLV to recover to an Sct_O₂ of 71% immediately after extubation.During SLV, all patients had a decrease of more than 15% ofthe initial Sct_O₂ and 70% of patients had a decrease of morethan 20%. The decrease in Sct_O₂ was not correlated with anystandard clinical parameters, for example, arterial pressure,blood loss, peripheral oxygen saturation, or Pa_O₂.

Conclusions: Thoracic surgery with SLV seems to be associated with a significantdecrease of Sct_O₂ in the majority of patients. Parameters suchas peripheral oxygen saturation or PO₂ which are used to guideSLV during thoracic surgery are not sufficient to detect significantcerebral oxygen desaturations.

Keywords: monitoring, intraoperative; surgery, thoracic; ventilation, single-lung

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This article has been cited by other articles:

R. Kazan, D. Bracco, and T. M. Hemmerling
Reduced cerebral oxygen saturation measured by absolute cerebral oximetry during thoracic surgery correlates with postoperative complications
Br. J. Anaesth., December 1, 2009; 103(6): 811 - 816.
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Significance in cerebral oxygen desaturation: Mark E Edsell; British Journal of Anaesthesia, 22 Dec 2008 [Full text]
Cerebral oxygen desaturations during single lung ventilation: Thomas M Hemmerling; British Journal of Anaesthesia, 29 Dec 2008 [Full text]