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Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
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Microvascular response to transfusion in elective spine surgery
J Matthias Walz1, Ottokar Stundner1, Federico P Girardi1
1J Matthias Walz, Stephen O Heard, Department of Anesthesiology and Perioperative Medicine, UMass Memorial Healthcare, Worcester, MA 01655, United States.
World Journal of Orthopedics
|February 2, 2017
Summary
Skeletal muscle oxygenation (SmO2) did not significantly correlate with hemodynamic or lab values during complex spine surgery. A small increase in SmO2 occurred during red blood cell transfusion, followed by a decline.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Surgical Oncology
- Physiology
Background:
- Complex spine surgeries often involve significant blood loss, necessitating transfusions.
- Monitoring tissue oxygenation, such as skeletal muscle oxygenation (SmO2), can provide insights into oxygen delivery and utilization.
- The relationship between transfusion, hemodynamic parameters, and SmO2 in this surgical context is not well-established.
Purpose of the Study:
- To investigate the microvascular skeletal muscle oxygenation (SmO2) response to blood product transfusion during complex spine surgery.
- To determine the correlation between SmO2 and invasive hemodynamic parameters and laboratory values.
- To assess the impact of packed red blood cell (PRBC) administration on SmO2.
Main Methods:
- Prospective study of 20 patients undergoing complex spine fusion surgery.
- Continuous monitoring of SmO2 using Near Infrared Spectroscopy (NIRS) and invasive hemodynamic parameters (e.g., SV, CO, CI, SVV).
- Interrupted time series analysis to evaluate the association between PRBC administration and SmO2, controlling for confounding factors.
Main Results:
- Pearson correlation coefficients between SmO2 and hemodynamic/laboratory parameters varied widely, with weak associations observed.
- A small, statistically significant increase in SmO2 (1.29 units) was noted at the time of PRBC administration (P=0.0002).
- Following PRBC administration, SmO2 values significantly declined by 0.015 units (P < 0.0001).
Conclusions:
- Intra-operative SmO2 measurements did not show a statistically significant correlation with invasive hemodynamic or laboratory parameters in patients undergoing complex spine surgery.
- The observed transient increase and subsequent decline in SmO2 following PRBC transfusion suggests a complex interplay of factors.
- Further research is needed to elucidate the clinical utility of SmO2 monitoring in guiding transfusion strategies during major surgical procedures.
