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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.

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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