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CARDIOVASCULAR ANESTHESIA

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

Jens Plachky, MD^*, Stefan Hofer, MD^*, Martin Volkmann, MD, Eike Martin, MD^*, Hubert J. Bardenheuer, MD^*, and Markus A. Weigand, MD DEAA^*

*Department of Anesthesiology, University of Heidelberg, Heidelberg, Germany; and Central Laboratory, Department of Internal Medicine, University of Heidelberg, Heidelberg, Germany

Address correspondence and reprint requests to Jens Plachky, MD, Department of Anesthesiology, University of Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg, Germany. Address e-mail to Jens_Plachky{at}med.uni-heidelberg.de

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 (rSO₂) and postoperative values of neuron-specific enolase (NSE) and S-100, which are specific variables that indicate cerebral disturbances due to hypoxia/ischemia. The rSO₂ 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 rSO₂ in eight patients, whereas the others tolerated clamping without major changes in rSO₂. The decrease in rSO₂ after clamping correlated significantly with postoperative increases in NSE (r² = 0.57) and S-100 (r² = 0.52). However, there were no significant differences between patients with and without rSO₂ decline concerning hemodynamic variables. There were no significant correlations between rSO₂ and cardiac output (r² = 0.20), NSE and cardiac output (r² = 0.37), or S-100 and cardiac output (r² = 0.24). Monitoring of rSO₂ may be a useful noninvasive tool to estimate disturbances in rSO₂ during OLT.

IMPLICATIONS: Neurologic complications contribute significantly to morbidity and mortality of patients after orthotopic liver transplantation (OLT). We investigated whether monitoring regional cerebral oxygen saturation (rSO₂) by near-infrared spectroscopy correlates with postoperative increases in neuron-specific enolase and S-100, two variables of cerebral tissue injury. The rSO₂ sensitively reflected transient cerebral hypoperfusion during OLT.

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