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Anesth Analg 2004;99:622-623
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000130907.93276.42

LETTERS TO THE EDITOR

Falsely Low Pulse Oximetry Values in Patients Receiving Docetaxel (Taxotere®)

Michael Paige, MD, and Philip E. Bickler, MD PhD

Anesthesia Resident Professor of Anesthesia, Department of Anesthesia and Perioperative Care, University of California at San Francisco, San Francisco, CA

To the Editor:

Pulse oximetry usually provides an accurate noninvasive estimate of arterial hemoglobin saturation, but errors can be produced by several confounding variables. Factors that can produce falsely low estimates of arterial hemoglobin saturation by pulse oximetry (SaO2) include the presence of methemoglobin (1) anemia combined with hypotension (2,3) motion (4), dark skin pigmentation including certain skin dyes (5), blue or green fingernail polish (6), and severe tricuspid regurgitation (7). We recently encountered a patient with docetaxel (Taxotere®)-induced nail bed changes that falsely depressed SaO2.

The patient was a 61-year-old woman who had received several courses of Taxotere for treatment of stage 4 breast cancer. We were contacted by nurses who were concerned that her measured SaO2 was 92–94% with the patient breathing room air. A Criticare® pulse oximeter with a Nellcor® probe was used. We noticed that the patient’s fingernails were a purplish color and were partially separated from the underlying tissues. These changes were consistent with existing reports of Taxotere-induced nail dystrophy (8,9,10). When the oximeter probe was attached to an unaffected toe, the oximeter read 97–99%, as did the probe when mounted sideways on a finger.

We have since seen erroneous SaO2 readings in another patient who had similar Taxotere-induced nail changes. Given the frequency with which Taxotere is used in treating both breast and lung cancers, it is important to be aware of the transcutaneous oximetric consequences of this therapy. Caution should therefore be exercised when using pulse oximetry to estimate arterial saturation in patients receiving Taxotere or related Taxol compounds.

References

  1. Watcha MF, Connor MT, Hing AV. Pulse oximetry in methemoglobinemia. Am J Dis Child 1989; 143: 845–7.[Abstract]
  2. Gehring H, Hornberger C, Matz H, et al. The effects of motion artifact and low perfusion on the performance of a new generation of pulse oximeters in volunteers undergoing hypoxemia. Respir Care 2002; 47: 48–60.[Medline]
  3. Severinghaus JW, Koh SO. Effect of anemia on pulse oximeter accuracy at low saturation. J Clin Monit 1990; 6: 85–8.[ISI][Medline]
  4. Barker SJ, Shah NK. The effects of motion on the performance of pulse oximeters in volunteers. Anesthesiology 1997; 86: 101–8.[ISI][Medline]
  5. al-Majed SA, Harakati MS. The effect of henna paste on oxygen saturation reading obtained by pulse oximetry. Trop Geogr Med 1994; 46: 38–9.[Medline]
  6. Cote CJ, Goldstein EA, Fuchsman WH, Hoaglin DC. The effect of nail polish on pulse oximetry. Anesth Analg 1988; 67: 683–6.[Abstract/Free Full Text]
  7. Stewart KG, Rowbottom SJ. Inaccuracy of pulse oximetry in patients with severe tricuspid regurgitation. Anaesthesia 1991; 46: 668–70.[Medline]
  8. Slee PH. Images in clinical medicine: nail changes after chemotherapy. N Engl J Med 1997; 337: 168.[Free Full Text]
  9. Pronk LC, Stoter G, Verweij J. Docetaxel (Taxotere): single agent activity, development of combination treatment and reducing side-effects. Cancer Treat Rev 1995; 21: 463–78.[Medline]
  10. Correia O, Azevedo C, Pinto Ferreira E, et al. Nail changes secondary to docetaxel (Taxotere). Dermatology 1999; 198: 288–90.[ISI][Medline]




This Article
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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