title: A mesenteric traction syndrome affects near-infrared spectroscopy evaluated cerebral oxygenation because skin blood flow increases.
abstract: During abdominal surgery manipulation of internal organs may induce a "mesenteric traction syndrome" (MTS) including a triad of flushing, hypotension, and tachycardia that lasts for about 30 min. We evaluated whether MTS affects near-infrared spectroscopy (NIRS) assessed frontal lobe oxygenation (ScO2) by an increase in forehead skin blood flow (SkBF). The study intended to include 10 patients who developed MTS during pancreaticoduodenectomy and 22 patients were enrolled (age 61 ± 8 years; mean ± SD). NIRS determined ScO2, laser Doppler flowmetry determined SkBF, cardiac output (CO) was evaluated by pulse-contour analysis (Modelflow), and transcranial Doppler assessed middle cerebral artery mean flow velocity (MCA Vmean). MTS was identified by flushing within 60 min after start of surgery. MTS developed 20 min (12-24; median with range) after the start of surgery and heart rate (78 ± 16 vs. 68 ± 17 bpm; P = 0.0032), CO (6.2 ± 1.4 vs. 5.3 ± 1.1 L min-1; P = 0.0086), SkBF (98 ± 35 vs. 80 ± 23 PU; P = 0.0271), and ScO2(71 ± 6 vs. 67 ± 8%; P < 0.0001), but not MCA Vmean(32 ± 8 vs. 32 ± 7; P = 0.1881) were largest in the patients who developed MTS. In some patients undergoing abdominal surgery NIRS-determined ScO2is at least temporarily affected by an increase in extra-cranial perfusion independent of cerebral blood flow as indicated by MCA Vmean. Thus, NIRS evaluation of ScO2may overestimate cerebral oxygenation if patients flush during surgery.
authors.affiliation: Department of Anaesthesia, Rigshospitalet 2043, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. niels.damkjaer.olesen.01@regionh.dk.|Department of Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark. niels.damkjaer.olesen.01@regionh.dk.
authors.forename: Niels D
authors.initials: ND
authors.lastname: Olesen
authors.affiliation: Department of Anaesthesia, Rigshospitalet 2043, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Sørensen
authors.affiliation: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Rikard
authors.initials: R
authors.lastname: Ambrus
authors.affiliation: Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Lars B
authors.initials: LB
authors.lastname: Svendsen
authors.affiliation: Department of Anaesthesia, Rigshospitalet 2043, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Anton
authors.initials: A
authors.lastname: Lund
authors.affiliation: Department of Anaesthesia, Rigshospitalet 2043, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Secher
mesh_terms: D000005:Abdomen / Q000601:surgery; D000368:Aged; D000758:Anesthesia / Q000379:methods; D001783:Blood Flow Velocity; D002560:Cerebrovascular Circulation; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000378:metabolism; D011446:Prospective Studies; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D012867:Skin / Q000098:blood supply* / Q000473:pathology; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013610:Tachycardia / Q000473:pathology; D018608:Ultrasonography, Doppler
chemical_list: D010100:Oxygen
keywords: Cerebral blood flow; Near-infrared spectroscopy; Pancreaticoduodenectomy; Skin blood flow; Transcranial Doppler ultrasonography