title: Factors affecting intraoperative changes in regional cerebral oxygen saturation in patients undergoing liver transplantation.
abstract: BACKGROUND
  Regional oxygen saturation (rSO(2)) is a sensitive marker of cerebral hypoperfusion during liver transplantation. However, bilirubin absorbs near-infrared light, resulting in falsely low rSO(2) values. We sought to determine whether rSO(2) values vary in response to bilirubin concentrations during liver transplantation and to assess whether rSO(2) changes were associated with factors reflecting cerebral oxygen delivery in patients with hyperbilirubinemia.
  
  
  METHODS
  Measurements of rSO(2) values continuous cardiac output (CO), mean arterial pressure, central venous pressure, body temperature, arterial blood gas analysis, and laboratory parameters were simultaneously performed at 1 hour after the surgical incision (baseline) and at 3 predetermined times during the anhepatic and neohepatic phases in 95 end-stage liver disease patients including 67 males of Child A/B/C/29/29/37 categories respectively. Relationships between changes in parameters were evaluated by correlation and multivariate regression analyses.
  
  
  RESULTS
  The 273 measurements revealed changes in rSO(2) (range, -18% to 40%) to correlate significantly with alterations in hemoglobin (Hb), serum glucose, lactate, prothrombin time, pH, partial arterial CO(2) pressure (PaCO(2)), and CO, but not with serum total bilirubin (TB). Multivariate linear regression analysis revealed that changes in Hb, CO, PaCO(2), and pH were independent of rSO(2) changes during liver transplantation.
  
  
  CONCLUSIONS
  Our findings showed that rSO(2) changes were independently associated with factors reflecting cerebral oxygen delivery, such as Hb, CO, PaCO(2), and pH, whereas rSO(2) values did not correlate with changes in bilirubin concentrations, indicating that rSO(2) changes reveal cerebral oxygen balance regardless of TB levels among patients undergoing liver transplantation.
authors: Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors: I-G
authors: IG
authors: Jun
authors: W-J
authors: WJ
authors: Shin
authors: Y-S
authors: YS
authors: Park
authors: J-G
authors: JG
authors: Song
authors: Y-K
authors: YK
authors: Kim
authors: G-S
authors: GS
authors: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D002302:Cardiac Output; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006932:Hyperbilirubinemia / Q000378:metabolism; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D018810:Magnetic Resonance Angiography; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism*; D010477:Perfusion; D012044:Regression Analysis; D019265:Spectroscopy, Near-Infrared
chemical_list: D010100:Oxygen