title: Dynamic muscle O2 saturation response is impaired during major non-cardiac surgery despite goal-directed haemodynamic therapy.
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 randomised 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 3 min 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.
authors: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania.
authors: A
authors: A
authors: Feldheiser
authors: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania.
authors: O
authors: O
authors: Hunsicker
authors: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania.
authors: L
authors: L
authors: Kaufner
authors: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania.
authors: J
authors: J
authors: Köhler
authors: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania.
authors: H
authors: H
authors: Sieglitz
authors: Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
authors: R
authors: R
authors: Casans Francés
authors: Charité-University Medicine Berlin and SOSTANA GmbH Berlin, Berlín, Alemania.
authors: K-D
authors: KD
authors: Wernecke
authors: Department of Gynaecology, European Competence Center for Ovarian Cancer, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlín, Alemania.
authors: J
authors: J
authors: Sehouli
authors: Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-University Medicine Berlin, Berlín, Alemania. Electronic address: claudia.spies@charite.de.
authors: C
authors: C
authors: Spies
mesh_terms: D006040:Goals; D006439:Hemodynamics; D006801:Humans; D010092:Oximetry; D010101:Oxygen Consumption; D019265:Spectroscopy, Near-Infrared
keywords: Cirugía; Espectroscopia cercana a infrarrojos; Goal-directed therapy; Haemodynamic; Hemodinámica; Near-infrared spectroscopy; Surgery; Terapia dirigida por objetivos; Test de oclusión vascular; Vascular occlusion test