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BMC Anesthesiology

, 14:122

Perioperative medicine and outcome

Abstract

BackgroundTissue hypoperfusion occurs frequently during surgery and may contribute to postoperative organ dysfunction. There is a need for perioperative treatment protocols aiming at improving tissue oxygenation StO2. We hypothesised that intra-operative optimisation of StO2 improves tissue perfusion and thus reduces postoperative complications. Furthermore, we evaluated the feasibility of the optimisation algorithm used.

MethodsWe randomized 50 high-risk patients, all >65 years with ASA physical status III, who underwent major abdominal surgery under standardized balanced general anesthesia combined with epidural analgesia. Throughout surgery StO2 was monitored at the thenar eminence using near-infrared spectroscopy. All patients were treated according to a standard care algorithm. In addition, patients in the intervention group were treated with dobutamine if necessary to keep or raise StO2 ≥ 80%. Data were recorded continuously and complications were recorded during hospital stay with a maximum of 28 days.

ResultsThe number of complications was not significantly different between groups 11 vs 20; p = 0.23. Eleven patients in the intervention group had no complication, versus 7 in the control group. There was no significant difference between groups in length of stay in ICU or in hospital. Only ten patients in the intervention group received dobutamine. Administration of dobutamine resulted in a moderate 6 -3 to 10 % increase of StO2. The overall protocol adherence was 94%.

ConclusionsNo statistically significant difference in outcome was realized through intraoperative optimization of StO2 values in this pilot study. The protocol used may be considered feasible for clinical practice. Further research is obligatory to define both the optimal StO2 threshold and intervention to treat tissue hypoperfusion.

Trial registrationClinicalTrials.gov identifier: NCT01342900. Registered 21 April 2011.

KeywordsTissue oxygenation Near-infrared spectroscopy Postoperative complications High-risk surgery Goal-directed therapy AbbreviationsBISBispectral monitoring

CetEffect site concentration

CICardiac index

COCardiac output

CVPCentral venous pressure

DO2Oxygen delivery

FFDFit for discharge

ICUIntensive care unit

NIRSNear infrared spectroscopy

PACUPost-anesthesia care unit

RBCRed blood cell

rSO2Regional cerebral oxygenation

ScvO2Central venous oxygen saturation

SpO2Oxygen saturation

StO2Tissue oxygenation

TCITarget-controlled infusion.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2253-14-122 contains supplementary material, which is available to authorized users.

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Autor: Paul A van Beest - Jaap Jan Vos - Marieke Poterman - Alain F Kalmar - Thomas WL Scheeren

Fuente: https://link.springer.com/







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