Regional Cerebral Oxygen Saturation Is a Sensitive Marker of Cerebral Hypoperfusion During Orthotopic Liver Transplantation

Abstract

Neurological complications contribute significantly to morbidity and mortality of patients after orthotopic liver transplantation (OLT). One possible cause of postoperative neurological complications is cerebral ischemia during the surgical procedure. In this study, we investigated the relationship between intraoperative changes in regional cerebral oxygen saturation (rSo(2)) and postoperative values of neuron-specific enolase (NSE) and S-100, which are specific variables that indicate cerebral disturbances due to hypoxia/ischemia. The rSo(2) was monitored continuously by near-infrared spectroscopy in 16 patients undergoing OLT. In addition, NSE and S-100 were determined in arterial blood before surgery and 24 h after reperfusion of the donor liver. Interestingly, clamping of the recipient's liver led to a significant decline in rSo(2) in eight patients, whereas the others tolerated clamping without major changes in rSo(2). The decrease in rSo(2) after clamping correlated significantly with postoperative increases in NSE (r(2) = 0.57) and S-100 (r(2) = 0.52). However, there were no significant differences between patients with and without rSo(2) decline concerning hemodynamic variables. There were no significant correlations between DeltarSo(2) and cardiac output (r(2) = 0.20), NSE and cardiac output (r(2) = 0.37), or S-100 and cardiac output (r(2) = 0.24). Monitoring of rSo(2) may be a useful noninvasive tool to estimate disturbances in rSo(2) during OLT.

Ventilatory strategy during liver transplantation: implications for near-infrared spectroscopy-determined frontal lobe oxygenation

“…In 22% of the patients, S c O 2 was reduced by >15% (relative to the value in the dissection phase) thus lowering the threshold for cerebral ischemia (Al-Rawi and Kirkpatrick, 2006). Similar significant cerebral deoxygenation is reported in up to 50% of patients undergoing LTx (Plachky et al, 2004), and also seen with the use of the piggy-back technique (Panzera et al, 2006). …”

Near-Infrared Spectroscopy for Evaluation of Cerebral Autoregulation During Orthotopic Liver Transplantation

“…Monitoring of frontal lobe oxygenation by NIRS is a noninvasive alternative to recording of changes in CBF [13]. Changes in S c O 2 parallel those in internal jugular venous O 2 saturation and middle cerebral artery mean flow velocity [4,14] and NIRS detects cerebral hypoperfusion during surgery [15]. The NIRS determined S c O 2 is based on the absorption of light in the spectra for oxygenated and deoxygenated hemoglobin and reports S c O 2 and S m O 2 as a percentage of light absorption by oxygenated to total hemoglobin.…”

Phenylephrine but not Ephedrine Reduces Frontal Lobe Oxygenation Following Anesthesia-Induced Hypotension

“…Changes in S c O 2 parallel those in internal jugular venous O 2 saturation and middle cerebral artery mean flow velocity [19] and NIRS detects cerebral hypoperfusion during surgery [20]. The NIRS determined S c O 2 is based on the absorption of light in the spectra for oxygenated and deoxygenated hemoglobin and reports S c O 2 as a percentage of light absorption by oxygenated to total hemoglobin.…”