474373 - cerebral desaturation during single lung ventilation correlates with postoperative morbidity.

Abstract

Introduction: The aim of this project was to determine regional cerebral oxygen saturation (SctO2) during single-lung ventilation (SLV) and thoracic surgery, assess its correlation with standard monitoring parameters and outcome parameters. METHODS: Local REB approval was obtained for this study. We used the FORE-SIGHTTM (CASMED, USA), a new cerebral oximeter measuring absolute cerebral tissue oxygen saturation in 50 patients undergoing lobectomy, requiring SLV. Left, right and average SctO2, BIS, peripheral oxygen saturation, mean blood pressure (BP) and heart rate (HR) were recorded every 5 min from induction to extubation. In addition, blood gas analysis were performed every 15 min during SLV. Data were analyzed using SAS software and non-parametric tests (median interquartiles). RESULTS: Preliminary results from 31 patients are presented. Patients (16 f; 15 m; 64 (57-70) years) had 90 (46 - 134) min of SLV during 130 (80 - 155) min of surgery. The cerebral saturation decreased to a minimum of 62 (56 - 64) % during SLV. No patient presented severe peripheral desaturation; arterial PaO2 was 163 (105 - 262) mmHg. There was no significant correlation between peripheral oxygen saturation, arterial blood gases changes, or any hemodynamic changes and cerebral oxygen desaturation. There was a positive correlation between the postoperative non-pulmonary organ failures (P<0.02), the postoperative complications (Clavien; P<0.05) and the decrease of SctO2 during SLV.Discussion: Thoracic surgery with SLV is associated with significant decrease of SctO2 in the majority of patients despite normal peripheral arterial oxygenation. Perioperative cerebral desaturation is correlated with postoperative complications and non-respiratory organ dysfunction. Further studies a required to assess possible underlying mechanisms.References: none.

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