A mesenteric traction syndrome affects near-infrared spectroscopy evaluated cerebral oxygenation because skin blood flow increases

摘要

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 (S~(c)O~(2)) 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 ScO~(2), 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 V~(mean)). 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 S~(c)O~(2)(71?±?6 vs. 67?±?8%; P ? P ?=?0.1881) were largest in the patients who developed MTS. In some patients undergoing abdominal surgery NIRS-determined S~(c)O~(2)is at least temporarily affected by an increase in extra-cranial perfusion independent of cerebral blood flow as indicated by MCA V~(mean). Thus, NIRS evaluation of S~(c)O~(2)may overestimate cerebral oxygenation if patients flush during surgery.