Artikel
Intraoperative measurement of pharynx / esophagus blood flow during anterior cervical surgery using laser doppler perfusion monitoring
Intraoperative Messung der Pharynx/Ösophagus Durchblutung mittels Laser-Doppler Perfusionsmonitoring bei anterioren zervikalen Eingriffen
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Autoren
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O. Heese
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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E. Fritzsche
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
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L. Papavero
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
Postoperative dysphagia after anterior cervical surgery is common. We hypothesise that direct pressure induced by retractor blades on pharynx/esophagus lead to local hypoperfusion and consequently postoperative hyperaemia and swelling of the pharynx / esophagus wall resulting in dysphagia. To prove this hypothesis, local blood flow during anterior cervical surgery in the pharynx / esophagus wall was measured using a laser doppler perfusion monitor unit. Measurement was performed directly underneath the medial retractor blade in order to gain information at the maximum point of pressure applied onto the pharynx / esphagus wall.
Methods
16 patients underwent standard anterior cervical fusion. A laser doppler probe was applied to the rear side of the medial retractor blade onto the pharynx / esophagus wall in all patients. In addition, mean arterial pressure (MAP) and endotracheal cuff pressure (ETCP) were recorded. Local perfusion was measured prior to retractor opening (5 min), during the operation and at the end of the procedure after closure of the retractor system (5 min). Perfusion was measured semiquantitatively in perfusion units (PU).
Results
Local perfusion ranged from 30 to 210 PU (mean 107) prior to retractor opening, from 7 to 60 PU (mean 30) with open retractor and from 15 to 280 PU (mean 117) after retractor closure. In all 16 patients, an open retractor led to hypoperfusion ranging from 21% to 93% compared to the baseline level. In 7 patients a reactive hyperaemia at the end of the procedure was detected (32% to 89% compared to baseline level). In 7 patients baseline levels were reached again at the end of the procedure after hypoperfusion and in 2 patients perfusion remained diminished even after retractor closure.
Conclusions
To our knowledge this is the first report on intraoperative measurement of local perfusion of the pharynx/esophagus during anterior cervical surgery. Diminished local perfusion during the procedure in all patients and post-procedure hyperaemia in 46% of the patients was observed in the pharynx / esophagus wall. This local ischemia in the pharynx/esophagus wall may be a crucial step in the development of postoperative dysphagia.
