JOURNAL HOME CME HOME THIS MONTH PAST ISSUES ETOC COLLECTIONS AUTHORS REVIEWERS EDITORIAL BOARD FEEDBACK RSS HELP
		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (8) Citing Articles via Google Scholar Google Scholar Articles by Madsen, P. L. Articles by Secher, N. H. Search for Related Content PubMed PubMed Citation Articles by Madsen, P. L. Articles by Secher, N. H.

---

GENERAL ARTICLES

Interference of Cerebral Near-Infrared Oximetry in Patients with Icterus

Per Lav Madsen, MD^*, Claus Skak, MD^*, Allan Rasmussen, MD, and Niels H. Secher, MD, PhD^*

Departments of *Anesthesia and Transplantation, Rigshospitalet, Copenhagen, Denmark

Address correspondence and reprint requests to Dr. Per Lav Madsen, Department of Anesthesia, Rigshospitalet 2041, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. Address e-mail to fyrrevang11{at}dadlnet.dk

Near-infrared spectrophotometry assesses cerebral oxygen saturation (ScO₂) based on the absorption spectra of oxygenated and deoxygenated hemoglobin and the translucency of biological tissue in the near-infrared band. In patients with icterus, however, bilirubin can potentially hinder cerebral oximetry. In 48 patients undergoing orthotopic liver transplantation, we related total plasma bilirubin to ScO₂ as determined from spectrophotometry with wavelengths of 733 and 809 nm. Before surgery, ScO₂ was 59% (15%–78%) (median with range) and bilirubin was 71 (6–619) µmol/L with a negative correlation (r = -0.72; P < 0.05). The 95% prediction interval included the lowest measurable ScO₂ of 15% at a bilirubin level of 370 µmol/L. During reperfusion of the grafted liver, the ScO₂ increased by 7% (-8% to 17%) (P < 0.05), and bilirubin did not influence this increase. In one patient, the ScO₂ remained below 15% despite a decrease in bilirubin from 619 to 125 µmol/L, suggesting that tissue pigmentation deposits also absorb light. In conclusion, bilirubin dampens the spectrophotometry-determined cerebral oxygen saturation at 733 and 809 nm. A bilirubin level of 370 µmol/L, tissue pigment deposits, or both, may render determination of cerebral oxygen saturation impossible. Even at high bilirubin values, changes in cerebral perfusion may be visible.

Implications: In 48 patients undergoing liver transplantation, the interference of icterus on cerebral oximetry by near-infrared light was investigated. Bilirubin absorbed the near-infrared light and lowered the measured cerebral oxygen saturation. Even at high bilirubin values, changes in cerebral oxygenation, as seen during reperfusion of the grafted liver, may be visible.

This article has been cited by other articles:

				D. L. McDonagh, M. R. McDaniel, and T. G. Monk The Effect of Intravenous Indigo Carmine on Near-Infrared Cerebral Oximetry Anesth. Analg., September 1, 2007; 105(3): 704 - 706. [Abstract] [Full Text] [PDF]

				J. Plachky, S. Hofer, M. Volkmann, E. Martin, H. J. Bardenheuer, and M. A. Weigand Regional Cerebral Oxygen Saturation Is a Sensitive Marker of Cerebral Hypoperfusion During Orthotopic Liver Transplantation Anesth. Analg., August 1, 2004; 99(2): 344 - 349. [Abstract] [Full Text] [PDF]

				H. B. Nielsen, F. S. Larsen, and P. L. Madsen Cerebral Oximetry and Hyperbilirubinemia Response Anesth. Analg., July 1, 2001; 93(1): 245 - 246. [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999