Anesth Pain Med.  2019 Jan;14(1):63-66. 10.17085/apm.2019.14.1.63.

Sustained erroneous near-infrared cerebral oxygen saturation in alert icteric patient with vanishing bile duct syndrome during and after liver transplantation: A case report

• Chung YH
• Lee SJ
• Koo BS
• Cho A
• Lee M
• Park J
• Kim SH

• KMID: 2434201
• DOI: http://doi.org/10.17085/apm.2019.14.1.63

Abstract

Monitoring cerebral oxygenation using a near infrared spectroscopy (NIRS) device is useful for estimating cerebral hypoperfusion and is available during liver transplantation (LT). However, high serum bilirubin concentration can interfere with NIRS because bilirubin absorbs near infrared light. We report a patient who underwent LT with a diagnosis of vanishing bile duct syndrome, whose regional cerebral oxygen saturation (rSOâ‚‚) remained below 15% even with alert mental status and SpO2â‚‚ value of 99%. The rSOâ‚‚ values were almost fixed at the lowest measurable level throughout the intra- and postoperative period. We report a case of erroneously low rSOâ‚‚ values during the perioperative period in a liver transplant recipient which might be attributable to skin pigmentation rather than higher serum bilirubin concentration.

Keyword

Bilirubin; Brain hypoxia; Hyperbilirubinemia; Liver transplantation; Nearinfrared spectroscopy; Oxymetry

MeSH Terms

Bile Ducts*
Bile*
Bilirubin
Diagnosis
Humans
Hyperbilirubinemia
Hypoxia, Brain
Liver Transplantation*
Liver*
Oxygen*
Perioperative Period
Postoperative Period
Skin Pigmentation
Spectrum Analysis
Transplant Recipients
Bilirubin
Oxygen

Figure

• 

  Fig. 1 Cerebral oximeter values before induction of anesthesia with alert mental status.

• 

  Fig. 2 A changing figure of regional cerebral oxygen saturation values during operation (recorded by vital recorder program).

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