Is fiber optic hepatovenous oximetry useful in patients undergoing elective partial liver resection?
Schaffranietz, L.; Pietsch, U.C.; Vetter, B.; Loch, T.; Lamesch, P.; Olthoff, D.
Anaesthesiologie und Reanimation 28(5): 125-130
ISSN/ISBN: 0323-4983 PMID: 14639993 Accession: 049413664
The validity of continuous measurement of hepatic venous oxygen saturation using a fibreoptic technique was investigated and set in correlation with intermittent measurements of saturation in hepatic venous blood in patients undergoing elective partial liver resection (pLR). Eleven patients (4 m/7 f, average age: 62.6 +/- 11.6 years) were included in the study after approval by the Ethics Committee of the University of Leipzig. A fibre-optic heparinized flow-directed pulmonary catheter (5.5-F) was inserted through the right internal jugular vein into the hepatic vein after induction of balanced anaesthesia (isoflurane/alfentanil). The position of the tip of the catheter was verified by fluoroscopic guidance. The oxygen saturation in the hepatic vein measured by the fibre-optic method and by blood-gas analysis (ShvO2) was compared at nine defined measuring points after in-vivo calibration (baseline). The ShvO2 decreased nonsignificantly from 84.4 +/- 10.4% to 77.1 +/- 19.1% during occlusion of the vessels in the liver hilus (Pringle's manoeuvre). The ShvO2 measured by the fibre-optic method and by blood-gas analysis correlated well (r = 0.815, p < 0.001). The limitations of the method result from artefacts based on surgical manipulations in the portal region (compression of hepatic veins, luxation of the liver). These artefacts can be differentiated by analysis of the pressure curves in the hepatic vein. Nevertheless, fibreoptic hepatovenous oxymetry seems to be a feasible method for continuous monitoring of the ShvO2 under intraoperative conditions in patients undergoing partial liver resection. Ischaemic situations of the liver can be detected and treated early. Additional information can be obtained from analyses of parameters in the hepatovenous blood.