title: Interference of cerebral near-infrared oximetry in patients with icterus.
abstract: Near-infrared spectrophotometry assesses cerebral oxygen saturation (ScO(2)) based on the absorption spectra of oxygenated and deoxygenated hemoglobin and the translucency of biological tissue in the near-infrared band. In patients with icterus, however, bilirubin can potentially hinder cerebral oximetry. In 48 patients undergoing orthotopic liver transplantation, we related total plasma bilirubin to ScO(2) as determined from spectrophotometry with wavelengths of 733 and 809 nm. Before surgery, ScO(2) was 59% (15%-78%) (median with range) and bilirubin was 71 (6-619) micromol/L with a negative correlation (r = -0.72; P < 0.05). The 95% prediction interval included the lowest measurable ScO(2) of 15% at a bilirubin level of 370 micromol/L. During reperfusion of the grafted liver, the ScO(2) increased by 7% (-8% to 17%) (P < 0.05), and bilirubin did not influence this increase. In one patient, the ScO(2) remained below 15% despite a decrease in bilirubin from 619 to 125 micromol/L, suggesting that tissue pigmentation deposits also absorb light. In conclusion, bilirubin dampens the spectrophotometry-determined cerebral oxygen saturation at 733 and 809 nm. A bilirubin level of 370 micromol/L, tissue pigment deposits, or both, may render determination of cerebral oxygen saturation impossible. Even at high bilirubin values, changes in cerebral perfusion may be visible.
  
  
  CONCLUSIONS
  In 48 patients undergoing liver transplantation, the interference of icterus on cerebral oximetry by near-infrared light was investigated. Bilirubin absorbed the near-infrared light and lowered the measured cerebral oxygen saturation. Even at high bilirubin values, changes in cerebral oxygenation, as seen during reperfusion of the grafted liver, may be visible.
authors.affiliation: Departments of Anesthesia and Transplantation, Rigshospitalet, Copenhagen, Denmark. fyrrevang11@dadlnet.dk
authors.forename: P L
authors.initials: PL
authors.lastname: Madsen
authors.forename: C
authors.initials: C
authors.lastname: Skak
authors.forename: A
authors.initials: A
authors.lastname: Rasmussen
authors.forename: N H
authors.initials: NH
authors.lastname: Secher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia; D001663:Bilirubin / Q000032:analysis; D001923:Brain Chemistry; D002245:Carbon Dioxide / Q000097:blood; D002560:Cerebrovascular Circulation; D005260:Female; D006339:Heart Rate; D006418:Heme / Q000737:chemistry; D006801:Humans; D007565:Jaundice / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010092:Oximetry / Q000379:methods; D010100:Oxygen / Q000097:blood; D019265:Spectroscopy, Near-Infrared
chemical_list: D002245:Carbon Dioxide; D006418:Heme; D001663:Bilirubin; D010100:Oxygen