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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Dynamic muscle O2 saturation response is impaired during major non-cardiac surge...
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Vol. 63. Issue 3.
Pages 149-158 (March 2016)
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Vol. 63. Issue 3.
Pages 149-158 (March 2016)
Original article
Dynamic muscle O2 saturation response is impaired during major non-cardiac surgery despite goal-directed haemodynamic therapy
La respuesta de la saturación dinámica muscular en cirugía no cardiaca se altera pese a la terapia hemodinámica dirigida por objetivos
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A. Feldheisera, O. Hunsickera, L. Kaufnera, J. Köhlera, H. Sieglitza, R. Casans Francésb, K.-D. Werneckec, J. Sehoulid, C. Spiesa,
Corresponding author
claudia.spies@charite.de

Corresponding author.
a Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlin, Germany
b Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
c Charité-University Medicine Berlin and SOSTANA GmbH Berlin, Berlin, Germany
d Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité–Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
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Tables (2)
Table 1. Demographic characteristics and tumour staging of study patients.
Table 2. Intraoperative and postoperative characteristics of study patients.
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Additional material (1)
Abstract
Background

Near-infrared spectroscopy combined with a vascular occlusion test (VOT) could indicate an impairment of microvascular reactivity (MVR) in septic patients by detecting changes in dynamic variables of muscle O2 saturation (StO2). However, in the perioperative context the consequences of surgical trauma on dynamic variables of muscle StO2 as indicators of MVR are still unknown.

Methods

This study is a sub-analysis of a randomized controlled trial in patients with metastatic primary ovarian cancer undergoing debulking surgery, during which a goal-directed haemodynamic algorithm was applied using oesophageal Doppler. During a 3min VOT, near-infrared spectroscopy was used to assess dynamic variables arising from changes in muscle StO2.

Results

At the beginning of surgery, values of desaturation and recovery slope were comparable to values obtained in healthy volunteers. During the course of surgery, both desaturation and recovery slope showed a gradual decrease. Concomitantly, the study population underwent a transition to a surgically induced systemic inflammatory response state shown by a gradual increase in norepinephrine administration, heart rate, and interleukin-6, with a peak immediately after the end of surgery. Higher rates of norepinephrine and a higher heart rate were related to a faster decline in StO2 during vascular occlusion.

Conclusions

Using near-infrared spectroscopy combined with a VOT during surgery showed a gradual deterioration of MVR in patients treated with optimal haemodynamic care. The deterioration of MVR was accompanied by the transition to a surgically induced systemic inflammatory response state.

Keywords:
Goal-directed therapy
Near-infrared spectroscopy
Surgery
Vascular occlusion test
Haemodynamic
Resumen
Introducción

En pacientes sépticos, la espectroscopia cercana a infrarrojos combinada con un test de oclusión vascular (VOT) puede indicar alteraciones de la reactividad microvascular (RMV) detectando cambios dinámicos de la saturación de oxígeno muscular (StO2). Sin embargo, se desconocen las consecuencias del trauma quirúrgico sobre la StO2 como indicador de RMV perioperatoria.

Métodos

Subanálisis de un ensayo clínico aleatorizado en pacientes con metástasis de cáncer primario de ovario sometidos a cirugía citorreductora donde se aplicó un algoritmo de terapia hemodinámica dirigida a objetivo mediante doppler esofágico. Tras un VOT de 3min, se valoraron cambios dinámicos de la StO2 muscular mediante espectroscopia cercana a infrarrojo.

Resultados

Al inicio de la cirugía, los valores de desaturación y las pendientes de recuperación de valores basales fueron comparables a los valores obtenidos en voluntarios sanos pero ambas mostraron disminuciones progresivas durante el transcurso de la misma. Simultáneamente, la población a estudio sufrió una transición a un estado de respuesta inflamatoria sistémica por estrés quirúrgico, mostrándose por un incremento progresivo de los requerimientos de norepinefrina, de la frecuencia cardiaca y de interleucina 6, y produciéndose un pico inmediatamente tras la cirugía. Las dosis altas de norepinefrina y la frecuencia cardiaca se correlacionaron con una disminución más rápida de StO2 durante el VOT.

Conclusiones

El uso combinado de espectroscopia cercana a infrarrojo y VOT durante la cirugía mostró un deterioro progresivo de la RMV en pacientes hemodinámicamente tratados de forma óptima. El deterioro de la RMV se acompañó de una transición a un estado de respuesta inflamatoria sistémica inducida por cirugía.

Palabras clave:
Terapia dirigida por objetivos
Espectroscopia cercana a infrarrojos
Cirugía
Test de oclusión vascular
Hemodinámica

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