Title:
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Methods of assessing the adequacy of
oxygen delivery in patients
undergoing major surgery
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This thesis examines several intra-operative physiological variables which may indicate
the adequacy of global oxygenation in patients undergoing major abdominal surgery.
Near infra-red spectroscopy is a non-invasive method to determine tissue oxygenation
based on the varying light absorption properties of oxygenated and non-oxygenated
substances, such as haemoglobin. This technique was used to assess the changes in
oxygen saturation of the thenar muscle (St02) in response to a vascular occlusion test
(VOT) of the arm where arteriovenous stasis is achieved using a pneumatic cuff for a pre-
determined period of time. Intra-operative St02 monitoring was also undertaken during
surgery. Results were obtained from 20 patients who underwent major non-laparoscopic
colorectal surgery. The VOT related St02 profile was different between patients who
exhibited complications, determined using a modified version of the post-operative
morbidity survey (POMS), and those who did not. In addition, a lower median intraoperative
St02 was associated with post-operative complications.
Microdialysis, an in vivo tissue sampling technique, was used to study the metabolic
changes in the lumen of the colon during colorectal surgery. A number of luminal
metabolites were related to oxygen delivery index suggesting a link between large bowel
metabolism and global oxygenation. Central venous saturation (Scy02) reflects the
balance between oxygen delivery and demand with a number of studies supporting its use
as a therapeutic haemodynamic target. This variable was measured intra-operatively and
examined in relation to oxygen delivery and post-operative outcome. In the 64 patients
studied, no relationship between oxygen delivery index and SCV02 was found and intraoperative
Scy02 was not associated with post-operative outcome.
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