Association of intraoperative tissue oxygenation with suspected risk factors for tissue hypoxia
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ORIGINAL RESEARCH
Association of intraoperative tissue oxygenation with suspected risk factors for tissue hypoxia R. J. Spruit • L. A. Schwarte • O. W. Hakenberg T. W. L. Scheeren
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Received: 13 November 2012 / Accepted: 22 March 2013 Ó Springer Science+Business Media New York 2013
Abstract Tissue hypoxia may cause organ dysfunction, but not much is known about tissue oxygenation in the intraoperative setting. We studied microcirculatory tissue oxygen saturation (StO2) to determine representative values for anesthetized patients undergoing urological surgery and to test the hypothesis that StO2 is associated with known perioperative risk factors for morbidity and mortality, conventionally monitored variables, and hypotension requiring norepinephrine. Using near-infrared spectroscopy, we measured StO2 on the thenar eminence in 160 patients undergoing open urological surgery under general anesthesia (FiO2 0.35–0.4), and calculated its correlations with age, risk level for general perioperative complications and mortality (high if age C70 and procedure is radical cystectomy), mean arterial pressure (MAP), hemoglobin concentration (Hb), central venous oxygen saturation (ScvO2), and norepinephrine use. The time averaged StO2 was 86 ± 6 % (mean ± SD). In the multivariate analysis, Hb [standardized coefficient (SC) 0.21, p = 0.003], ScvO2 (SC 0.53, p \ 0.001) and high risk level (SC 0.06, p = 0.03) were
Presented in part at the Euroanaesthesia 2011 in Amsterdam, The Netherlands; June 11th–14th 2011. R. J. Spruit (&) T. W. L. Scheeren Department of Anaesthesiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands e-mail: [email protected] L. A. Schwarte Department of Anesthesiology, VU University Medical Center, Amsterdam, The Netherlands O. W. Hakenberg Department of Urology, University Hospital Rostock, Rostock, Germany
significant independent variables correlated with StO2. StO2 was partly dependent on MAP only when this was below 65 mmHg (lowest MAP SC 0.20, p = 0.006, MAP area under the curve \65 mmHg SC 0.03, p = 0.02). Finally, StO2 was slightly lower in patients requiring norepinephrine (85 ± 6 vs. 89 ± 6 %, p = 0.001). Intraoperative StO2 in urological patients was comparable to that of healthy volunteers breathing room air as reported in the literature and correlated with known perioperative risk factors. Further research should investigate its association with outcome and the effect of interventions aimed at optimizing StO2. Keywords Anesthesia, general Blood pressure Microcirculation Monitoring, oxygen/metabolism Tissue oxygenation Spectroscopy, near-infrared
1 Introduction One of the major goals in perioperative patient care is providing organs and tissues with sufficient oxygen for cellular metabolism and function in order to prevent or at least reduce morbidity and mortality. Intraoperative hypoxia may cause postoperative organ dysfunction and subsequently perioperative morbidity and mortality [1]. Other factors affecting perioperative outcom
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