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Effect of posture and extracranial contamination on results of cerebral oximetry by near-infrared spectroscopy

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Abstract

Background

Near-infrared spectroscopy (NIRS)-based cerebral oximetry is a noninvasive technology used to estimate regional cerebral oxygen saturation (rSO2). Extracranial blood flow is known to substantially affect rSO2 values measured by most clinically available devices. Several studies have also reported that the Trendelenburg position and upright position have a larger effect on rSO2 measurements than the supine position. Therefore, we investigated the effect of these two positions (the Trendelenburg position versus the upright position) and extracranial contamination on rSO2 measurements obtained using two commercially available devices and one prototype device.

Methods

Twelve healthy volunteers were enrolled in the study. They each had three cerebral oximetry devices applied to their forehead (FORE-SIGHT ELITE™, CAS Medical Systems Inc., Branford, CT, USA; INVOS 5100c™, Medtronic, Minneapolis, MN, USA; and NIRO-TRS, Hamamatsu Photonics, Hamamatsu, Japan). A circumferential pneumatic head cuff was positioned proximal to the NIRS cerebral oximetry sensors. We measured rSO2, heart rate (HR), and blood pressure (BP) in six conditions (supine, Trendelenburg and upright positions, with and without scalp ischemia induced by head cuff inflation) every 5 min with each oximetry device. Total hemoglobin (tHb), which is associated with cerebral blood volume (CBV) as measured by positron emission tomography, was measured using the NIRO-TRS device to determine extracranial blood volume in each position.

Results

Measurements of rSO2 with all the devices were affected by extracranial contamination. The percentage of extracranial contamination was highest with INVOS 5100c™ in the upright position (INVOS, 21.3%; FORE-SIGHT, 14.3%; NIRO-TRS, 3.6%). Measurements of rSO2 obtained in the upright position were significantly lower than those obtained in the supine position, using INVOS-5100c™ and FORE-SIGHT ELITE™ (71 vs. 74% and 67 vs. 72%, respectively), but not using NIRO-TRS (62 vs. 64%). A significant decrease in tHb was observed after head cuff inflation in the supine and Trendelenburg positions (supine, 0.132–0.123 μmol/l; Trendelenburg, 0.133–0.125 μmol/l).

Conclusions

Except when using NIRO-TRS, measurements of rSO2 in the forehead are significantly lower when measured in the upright position than in the supine position. All devices in this study were affected by extracranial contamination.

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References

  1. Jobsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977;198(4323):1264–7.

    Article  CAS  PubMed  Google Scholar 

  2. Ferrari M, Giannini I, Sideri G, Zanette E. Continuous non invasive monitoring of human brain by near-infrared spectroscopy. Adv Exp Med Biol. 1985;191:873–82.

    Article  CAS  PubMed  Google Scholar 

  3. Murkin JM, Arango M. Near-infrared spectroscopy as an index of brain and tissue oxygenation. Br J Anaesth. 2009;103(Suppl 1):i3–13.

    Article  PubMed  Google Scholar 

  4. McCormick PW, Stewart M, Goetting MG, Dujovny M, Lewis G, Ausman JI. Noninvasive cerebral optical spectroscopy for monitoring cerebral oxygen delivery and hemodynamics. Crit Care Med. 1991;19(1):89–97.

    Article  CAS  PubMed  Google Scholar 

  5. Yoshitani K, Kawaguchi M, Miura N, Okuno T, Kanoda T, Ohnishi Y, Kuro M. Effects of hemoglobin concentration, skull thickness, and the area of the cerebrospinal fluid layer on near-infrared spectroscopy measurements. Anesthesiology. 2007;106(3):458–62.

    Article  PubMed  Google Scholar 

  6. Yoshitani K, Kuwajima K, Irie T, Inatomi Y, Miyazaki A, Iihara K, Ohnishi Y. Clinical validity of cerebral oxygen saturation measured by time-resolved spectroscopy during carotid endarterectomy. J Neurosurg Anesthesiol. 2013;25(3):248–53.

    Article  PubMed  Google Scholar 

  7. Kalmar AF, Foubert L, Hendrickx JF, Mottrie A, Absalom A, Mortier EP, Struys MM. Influence of steep Trendelenburg position and CO(2) pneumoperitoneum on cardiovascular, cerebrovascular, and respiratory homeostasis during robotic prostatectomy. Br J Anaesth. 2010;104(4):433–9.

    Article  CAS  PubMed  Google Scholar 

  8. Park EY, Koo BN, Min KT, Nam SH. The effect of pneumoperitoneum in the steep Trendelenburg position on cerebral oxygenation. Acta Anaesthesiol Scand. 2009;53(7):895–9.

    Article  CAS  PubMed  Google Scholar 

  9. Lee JR, Lee PB, Do SH, Jeon YT, Lee JM, Hwang JY, Han SH. The effect of gynaecological laparoscopic surgery on cerebral oxygenation. J Int Med Res. 2006;34(5):531–6.

    Article  CAS  PubMed  Google Scholar 

  10. Tange K, Kinoshita H, Minonishi T, Hatakeyama N, Matsuda N, Yamazaki M, Hatano Y. Cerebral oxygenation in the beach chair position before and during general anesthesia. Minerva Anestesiol. 2010;76(7):485–90.

    CAS  PubMed  Google Scholar 

  11. Closhen D, Berres M, Werner C, Engelhard K, Schramm P. Influence of beach chair position on cerebral oxygen saturation: a comparison of INVOS and FORE-SIGHT cerebral oximeter. J Neurosurg Anesthesiol. 2013;25(4):414–9.

    Article  PubMed  Google Scholar 

  12. Mehagnoul-Schipper DJ, Vloet LC, Colier WN, Hoefnagels WH, Jansen RW. Cerebral oxygenation declines in healthy elderly subjects in response to assuming the upright position. Stroke. 2000;31(7):1615–20.

    Article  CAS  PubMed  Google Scholar 

  13. Young AE, Germon TJ, Barnett NJ, Manara AR, Nelson RJ. Behaviour of near-infrared light in the adult human head: implications for clinical near-infrared spectroscopy. Br J Anaesth. 2000;84(1):38–42.

    Article  CAS  PubMed  Google Scholar 

  14. Davie SN, Grocott HP. Impact of extracranial contamination on regional cerebral oxygen saturation: a comparison of three cerebral oximetry technologies. Anesthesiology. 2012;116(4):834–40.

    Article  CAS  PubMed  Google Scholar 

  15. Greenberg S, Murphy G, Shear T, Patel A, Simpson A, Szokol J, Avram MJ, Vender J. Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers. Can J Anaesth. 2016;63:24–30.

    Article  PubMed  Google Scholar 

  16. Ijichi S, Kusaka T, Isobe K, Islam F, Okubo K, Okada H, Namba M, Kawada K, Imai T, Itoh S. Quantification of cerebral hemoglobin as a function of oxygenation using near-infrared time-resolved spectroscopy in a piglet model of hypoxia. J Biomed Opt. 2005;10(2):024026.

    Article  PubMed  Google Scholar 

  17. Ohmae E, Ouchi Y, Oda M, Suzuki T, Nobesawa S, Kanno T, Yoshikawa E, Futatsubashi M, Ueda Y, Okada H, Yamashita Y. Cerebral hemodynamics evaluation by near-infrared time-resolved spectroscopy: correlation with simultaneous positron emission tomography measurements. NeuroImage. 2006;29(3):697–705.

    Article  PubMed  Google Scholar 

  18. Patterson MS, Chance B, Wilson BC. Time resolved reflectance and transmittance for the non-invasive measurement of tissue optical properties. Appl Opt. 1989;28(12):2331–6.

    Article  CAS  PubMed  Google Scholar 

  19. Sato C, Yamaguchi T, Seida M, Ota Y, Yu I, Iguchi Y, Nemoto M, Hoshi Y. Intraoperative monitoring of depth-dependent hemoglobin concentration changes during carotid endarterectomy by time-resolved spectroscopy. Appl Opt. 2007;46(14):2785–92.

    Article  CAS  PubMed  Google Scholar 

  20. Kurihara K, Kikukawa A, Kobayashi A. Cerebral oxygenation monitor during head-up and -down tilt using near-infrared spatially resolved spectroscopy. Clin Physiol Funct Imaging. 2003;23(4):177–81.

    Article  CAS  PubMed  Google Scholar 

  21. Krakow K, Ries S, Daffertshofer M, Hennerici M. Simultaneous assessment of brain tissue oxygenation and cerebral perfusion during orthostatic stress. Eur Neurol. 2000;43(1):39–46.

    Article  CAS  PubMed  Google Scholar 

  22. Yoshitani K, Kawaguchi M, Tatsumi K, Kitaguchi K, Furuya H. A comparison of the INVOS 4100 and the NIRO 300 near-infrared spectrophotometers. Anesth Analg. 2002;94(3):586–90 (table of contents).

  23. Al-Rawi PG, Smielewski P, Kirkpatrick PJ. Evaluation of a near-infrared spectrometer (NIRO 300) for the detection of intracranial oxygenation changes in the adult head. Stroke. 2001;32(11):2492–500.

    Article  CAS  PubMed  Google Scholar 

  24. Edgell H, Robertson AD, Hughson RL. Hemodynamics and brain blood flow during posture change in younger women and postmenopausal women compared with age-matched men. J Appl Physiol (1985). 2012;112(9):1482–93.

    Article  CAS  Google Scholar 

  25. van Lieshout JJ, Pott F, Madsen PL, van Goudoever J, Secher NH. Muscle tensing during standing: effects on cerebral tissue oxygenation and cerebral artery blood velocity. Stroke. 2001;32(7):1546–51.

    Article  PubMed  Google Scholar 

  26. Powers WJ, Press GA, Grubb RL Jr, Gado M, Raichle ME. The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med. 1987;106(1):27–34.

    Article  CAS  PubMed  Google Scholar 

  27. Del Bianco S, Martelli F, Zaccanti G. Penetration depth of light re-emitted by a diffusive medium: theoretical and experimental investigation. Phys Med Biol. 2002;47(23):4131–44.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Anesthesiology, National Cerebral and Cardiovascular Center, Fujishirodai, Suita, Osaka, 565-8565, Japan

    Shinya Kato, Kenji Yoshitani, Yosuke Kubota, Yuzuru Inatomi & Yoshihiko Ohnishi

  2. Department of Anesthesiology, Tokyo Medical University, Nishi-Shinjuku, Shinjuku, Tokyo, 160-0023, Japan

    Shinya Kato & Kenji Yoshitani

Authors
  1. Shinya Kato
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  2. Kenji Yoshitani
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  3. Yosuke Kubota
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  4. Yuzuru Inatomi
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  5. Yoshihiko Ohnishi
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Corresponding author

Correspondence to Kenji Yoshitani.

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Funding

This work was supported by department funding.

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Kato, S., Yoshitani, K., Kubota, Y. et al. Effect of posture and extracranial contamination on results of cerebral oximetry by near-infrared spectroscopy. J Anesth 31, 103–110 (2017). https://doi.org/10.1007/s00540-016-2275-1

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  • DOI: https://doi.org/10.1007/s00540-016-2275-1

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