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Anesth Analg 2004;98:553
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000077715.21575.80

LETTERS TO THE EDITOR

Oculocutaneous Albinism and Spurious Pulse Oximetry

Indu Sen, MD, Deepak Thapa, MD, and Kanti K. Gombar, MD

Department of Anaesthesia and Critical Care, Government Medical College and Hospital, Chandigarh, India

To the Editor:

A 39-yr-old female patient with oculocutaneous albinism (OCA) underwent total abdominal hysterectomy. She had been using Babchi (Psoralea corylifolia) herb extract for OCA. Bavachinin–A, a flavanone isolated from its fruits, is an irritant with photosensitizing properties. Preanesthetic evaluation, laboratory investigations, and chest radiograph were normal. Soon after induction of general anesthesia, oxygen saturation (SpO2) gradually decreased from 99% to 85% (Datex Ohmeda, 5250 RGM). Bilateral ventilation of lungs was normal by auscultation. Hemodynamic stability, normothermia, and good pulse signal indicated that the digital probe was correctly positioned on the finger (1). Clinically, the patient appeared well oxygenated. Arterial blood gas analysis showed PaO2—104 mm Hg. SpO2, although it improved after reapplication of probe, again decreased, and low SpO2 readings were frequently observed intraoperatively, necessitating repeated change of sensor-test site. The patient did not complain of respiratory discomfort after recovery. Literature review on effects of skin pigmentation on pulse oximetry revealed reports of Spo2 underestimation in dark individuals (2). OCA is an autosomal recessive trait, characterized by tyrosinase deficiency, interrupting melanosomes formation in skin and hair. Its other variants, such as yellow mutant, Hermansky-Pudlak syndrome, and Chedlak-Higashi syndrome, may have hematological abnormalities. Reduced melanin decreases visual acuity and enhances sensitivity to ultraviolet light. This case suggests that perhaps the sensitivity to the two light wavelengths (660 nm, 940 nm) utilized by pulse oximeter is affected in OCA (3).

Herbal remedies may include ingredients exerting chemical effects (4). Can Babchi affect SpO2 estimation?

References:

  1. Barker SJ, Hyatt J, Shah NK, Kao YJ. The effect of sensor malpositioning on pulse oximeter accuracy during hypoxemia. Anesthesiology 1993; 79: 248–54.[ISI][Medline]
  2. Adler JN, Hughes LA, Vivilecchia R, Camargo CA Jr. Effect of skin pigmentation on pulse oximetry accuracy in the emergency department. Acad Emerg Med 1998; 5: 965–70.[ISI][Medline]
  3. Moon RE, Comporesi EM. Respiratory monitoring. In: Ronald D Miller, eds. Anesthesia. 5th ed. New York : Churchill Livingstone, 2000: 1255–95.
  4. Miller LG. Herbal medicines: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med 1998; 158: 2200–11.[Abstract/Free Full Text]



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Lippincott, Williams & Wilkins 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 HighWire Press