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BJA Advance Access published online on October 3, 2008
British Journal of Anaesthesia, doi:10.1093/bja/aen275
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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 causes important cardiopulmonary disturbances. Absolute cerebral oximetry was used to determine the incidence and magnitude of the decrease in cerebral oxygen saturation (SctO2) in patients undergoing SLV during thoracic surgery.

Methods: Data were obtained from 20 consecutive patients undergoing thoracic surgery and necessitating SLV of more than 1 h. The FORESIGHTTM (CASMED, USA) absolute oximeter was used to measure left, right, and average absolute SctO2 every 5 min from the awake state to extubation. Bispectral index and standard monitoring parameters were also recorded every 5 min. Blood gas analysis was performed every 15 min. Data median (IQR) (range) were analysed using repeated-measures ANOVA and Spearman’s correlation test, P<0.05.

Results: Patients [median age 65 yr (range 46–75)] showed an absolute SctO2 of 80% (78, 82) (74–87) in the awake state, which decreased to a minimum SctO2 value of 63% (57, 65) (53–73) during SLV to recover to an SctO2 of 71% immediately after extubation. During SLV, all patients had a decrease of more than 15% of the initial SctO2 and 70% of patients had a decrease of more than 20%. The decrease in SctO2 was not correlated with any standard clinical parameters, for example, arterial pressure, blood loss, peripheral oxygen saturation, or PaO2.

Conclusions: Thoracic surgery with SLV seems to be associated with a significant decrease of SctO2 in the majority of patients. Parameters such as peripheral oxygen saturation or PO2 which are used to guide SLV during thoracic surgery are not sufficient to detect significant cerebral oxygen desaturations.

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


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 Br J AnaesthHome page
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.
[Abstract] [Full Text] [PDF]

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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]

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