J Clin Monit Comput - The impact of induction of general anesthesia and a vascular occlusion test on tissue oxygen saturation derived parameters in high-risk surgical patients.

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Resumo

JECTIVES: Tissue oxygen saturation (StO(2)) assessed using Near Infrared Spectroscopy and its derived parameters during a vascular occlusion test (VOT) can detect microvascular changes in septic shock patients. General anesthesia (GA) impacts microcirculation. Our aim was to study the effects of general anesthesia on StO(2) and StO(2) derived parameters obtained during VOT in patients referred for cardiac surgery.METHODS: We studied 15 patients referred for cardiac surgery before and after induction of GA. Before GA induction, we also studied 15 healthy volunteers (non patients) in order to compare baseline physiological data between patients and healthy subjects. Hemodynamic and microcirculatory (StO(2), ischemic slope, reperfusion slope, and hyperemic response) data were recorded at each step. We used the Inspectra StO(2) system (Hutchinson Inc, MN, USA) with a sensor placed on the thenar eminence. StO(2) values were obtained at baseline and during a VOT. A sphyngomanometer was placed on the forearm above the StO(2) probe and the cuff was then rapidly inflated 30?mmHg above systolic pressure and was maintained inflated until the StO(2) value reached 40%. It was then rapidly deflated.RESULTS: Healthy volunteers had significantly higher reperfusion slope than patients (348 [251-393] vs. 261 [185-279] %/min; P<0.05). GA induction induced no significant change in StO(2) value compared to baseline (79 [75-85] vs. 80 [76-86]%; P?=?0.57). We observed a significant decrease in ischemic slope (from -12 [-16--8] to -8 [-10--6] %/min; P?=?0.004) and in reperfusion slope (from 261 [185-279] %/min to 164 [151-222] %/min; P?=?0.008) suggesting a decrease in local metabolic rate and a negative impact on reperfusion reserve induced by anesthesia.CONCLUSION: StO(2) derived parameters during a VOT are impacted by GA induction. These parameters may have potential for microcirculation assessment in patients undergoing surgery.

Resumo Limpo

jectiv tissu oxygen satur sto assess use near infrar spectroscopi deriv paramet vascular occlus test vot can detect microvascular chang septic shock patient general anesthesia ga impact microcircul aim studi effect general anesthesia sto sto deriv paramet obtain vot patient refer cardiac surgerymethod studi patient refer cardiac surgeri induct ga ga induct also studi healthi volunt non patient order compar baselin physiolog data patient healthi subject hemodynam microcirculatori sto ischem slope reperfus slope hyperem respons data record step use inspectra sto system hutchinson inc mn usa sensor place thenar emin sto valu obtain baselin vot sphyngomanomet place forearm sto probe cuff rapid inflat mmhg systol pressur maintain inflat sto valu reach rapid deflatedresult healthi volunt signific higher reperfus slope patient vs min p ga induct induc signific chang sto valu compar baselin vs p observ signific decreas ischem slope min p reperfus slope min min p suggest decreas local metabol rate negat impact reperfus reserv induc anesthesiaconclus sto deriv paramet vot impact ga induct paramet may potenti microcircul assess patient undergo surgeri

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