Comparison of systemic oxygen delivery and uptake with NIR spectroscopy of brain during normovolemic hemodilution in the rabbit.
Incremental hyperoxic normovolemic hemodilution was utilized to progressively decrease oxygen delivery (DO2) in anesthetized rabbits. At decreasing DO2, we compared systemic responses related to the adequacy of DO2, i.e. mixed venous oxygen saturation (SvO2), oxygen consumption (VO2), and arterial lactate concentrations, to near infrared spectroscopy (NIRS) of the brain, a regional measure of intracellular oxygen availability. We sought concomitantly to define critical SvO2 and DO2, beyond which whole body VO2 begins to decline and arterial lactate concentrations increase. NIR Spectroscopy provided the means to test the hypothesis that systemic indicators of inadequate DO2 would not accurately reflect the oxygenation of a critical organ such as the brain. In thirteen rabbits anesthetized with fentanyl, paralyzed and artificially ventilated at an FIO2 of 0.60, hemodilution produced an early decrease in mixed venous oxygen saturation. When mixed venous oxygen saturation decreased below approximately 50%, arterial lactate concentrations began to increase significantly. Further decreases in oxygen delivery precipitated a decline in systemic VO2. Finally, NIRS revealed an increase in the reduction level of brain cytochrome a,a3 after systemic parameters of oxygen delivery had been altered. Analysis of the data indicated that falling SvO2 predicted inadequate DO2 to tissue during early hemodilution under narcotic/relaxant anesthesia and that the brain showed evidence of intracellular hypoxia only after systemic parameters such as SvO2 were affected markedly.
Lubarsky
D A
DA
Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710.
Griebel
J A
JA
Carnporesi
E M
EM
Piantadosi
C A
CA
D000768:Anesthesia, General; D000818:Animals; D001921:Brain / Q000378:metabolism*; D002302:Cardiac Output / Q000502:physiology; D003576:Electron Transport Complex IV / Q000378:metabolism*; D005283:Fentanyl; D006438:Hemodilution; D016343:Monitoring, Intraoperative / Q000379:methods; D010084:Oxidation-Reduction; D010101:Oxygen Consumption / Q000502:physiology*; D011817:Rabbits; D013055:Spectrophotometry, Infrared
D003576:Electron Transport Complex IV; D005283:Fentanyl