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Dominelli PB, Baker SE, Wiggins CC, Stewart GM, Sajgalik P, Shepherd JRA, Roberts SK, Roy TK, Curry TB, Hoyer JD, Oliveira JL, Foster GE, Joyner MJ. Dissociating the effects of oxygen pressure and content on the control of breathing and acute hypoxic response. J Appl Physiol (1985) 2019; 127:1622-1631. [PMID: 31647724 PMCID: PMC6962610 DOI: 10.1152/japplphysiol.00569.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022] Open
Abstract
Arterial oxygen tension and oxyhemoglobin saturation (S a O 2 ) decrease in parallel during hypoxia. Distinguishing between changes in oxygen tension and oxygen content as the relevant physiological stimulus for cardiorespiratory alterations remains challenging. To overcome this, we recruited nine individuals with hemoglobinopathy manifesting as high-affinity hemoglobin [HAH; partial pressure at 50% S a O 2 (P50) = 16 ± 0.4 mmHg] causing greater S a O 2 at a given oxygen partial pressure compared with control subjects (n = 12, P50 = 26 ± 0.4 mmHg). We assessed ventilatory and cardiovascular responses to acute isocapnic hypoxia, iso-oxic hypercapnia, and 20 min of isocapnic hypoxia (arterial Po2 = 50 mmHg). Blood gas alterations were achieved with dynamic end-tidal forcing. When expressed as a function of the logarithm of oxygen partial pressure, ventilatory sensitivity to hypoxia was not different between groups. However, there was a significant difference when expressed as a function of S a O 2 . Conversely, the rise in heart rate was blunted in HAH subjects when expressed as a function of partial pressure but similar when expressed as a function of S a O 2 . Ventilatory sensitivity to hypercapnia was not different between groups. During sustained isocapnic hypoxia, the rise in minute ventilation was similar between groups; however, heart rate was significantly greater in the controls during 3 to 9 min of exposure. Our results support the notion that oxygen tension, not content, alters cellular Po2 in the chemosensors and drives the hypoxic ventilatory response. Our study suggests that in addition to oxygen partial pressure, oxygen content may also influence the heart rate response to hypoxia.NEW & NOTEWORTHY We dissociated the effects of oxygen content and pressure of cardiorespiratory regulation studying individuals with high-affinity hemoglobin (HAH). During hypoxia, the ventilatory response, expressed as a function of oxygen tension, was similar between HAH variants and controls; however, the rise in heart rate was blunted in the variants. Our work supports the notion that the hypoxic ventilatory response is regulated by oxygen tension, whereas cardiovascular regulation may be influenced by arterial oxygen content and tension.
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Affiliation(s)
- Paolo B Dominelli
- Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sarah E Baker
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Chad C Wiggins
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Glenn M Stewart
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Pavol Sajgalik
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - John R A Shepherd
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Shelly K Roberts
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tuhin K Roy
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Timothy B Curry
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - James D Hoyer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Jennifer L Oliveira
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Glen E Foster
- School of Health and Exercise Science, University of British Columbia, Kelowna, British Columbia, Canada
| | - Michael J Joyner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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2
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Cirenei C, Veyckemans F, Barbati M, Bert D, Laffargue-Vetter A, Richart P. Fluctuating Pulse Oximetry Readings in an Adolescent With Hemoglobin Bibba: A Case Report. A A Pract 2018; 11:52-53. [DOI: 10.1213/xaa.0000000000000737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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3
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Vanner R, Cho R, Weinstein M. A Healthy Infant Incidentally Presenting With Low SpO 2: The Pitfalls of Pulse Oximetry. Clin Pediatr (Phila) 2018; 57:113-116. [PMID: 27941085 DOI: 10.1177/0009922816681604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robert Vanner
- 1 MD Program, University of Toronto, Toronto, Ontario, Canada
| | - Romy Cho
- 2 Department of Paediatrics, SickKids, Toronto, Ontario, Canada
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4
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Brugger S, Santafé-Marti MD, Lakhal M. Low SpO2 With Normal SaO2 During General Anesthesia: A Case Report. A & A CASE REPORTS 2017; 9:197-198. [PMID: 28542050 DOI: 10.1213/xaa.0000000000000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A 25-year-old Caucasian man with a history of spherocytosis, splenectomy, recurrent blood transfusion, and no cardiopulmonary disease presented for an emergent laparoscopic cholecystectomy with a baseline pulse oximetric saturation (SpO2) of 88% while breathing room air. The SpO2 increased to only 89% during preoxygenation with an FIO2 1.0. Multiple arterial blood samples revealed SaO2 as high as 100% with PaO2 averaging 390 mm Hg. He was subsequently diagnosed with a dyshemoglobin, hemoglobin Köln. The simultaneous presentation of a stable patient from a cardiopulmonary perspective with normal arterial oxygen tension and saturation in the blood gas analyses despite a low SpO2 measurement outlines the importance of integrating the history of present illness and both the importance and the limitation of the pulse oximetry.
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Affiliation(s)
- Stefan Brugger
- From the University Heart Center Freiburg, Freiburg, Germany
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5
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Waters AM, Caboot JB, Verhovsek MM, Harper DP, Forouhar MA. Hb Grifton [α87(F8)His→Pro; HBA1: C.263A > C (or HBA2)] Causes Abnormal Pulse Oximetry Measurements. Hemoglobin 2016; 40:257-9. [PMID: 27225845 DOI: 10.1080/03630269.2016.1174872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
An asymptomatic toddler and his mother consistently demonstrated low transcutaneous pulse oximetry (SpO2) measurements, discordant with normal arterial blood gas analyses while breathing room air. Previous evaluations by medical teams were unable to identify an etiology of their perceived hypoxia. Further investigation revealed that the boy carried an abnormal variant, Hb Grifton or α87(F8)His→Pro; HBA1: c.263A > C (or HBA2), discovered on newborn screening, which was not suspected as the underlying cause of his abnormal pulse oximetry readings until an inpatient admission to our hospital for asymptomatic "hypoxia," where he was found to share these same characteristics with his mother. We showed that a difference in light absorption between the oxygenated Hb Grifton variant and oxygenated Hb A resulted in erroneous pulse oximetry values. This phenomenon has previously been reported in a handful of other variant Hbs. Astute clinical suspicion, in conjunction with laboratory testing leading to correct diagnoses of variant Hbs, may prevent expensive work-ups and unnecessary medical treatments for asymptomatic patients falsely presumed to be hypoxemic based on low pulse oximetry measurements.
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Affiliation(s)
- Aubri M Waters
- a Department of Pediatrics , Carl R. Darnall Army Medical Center , Fort Hood , TX , USA
| | - Jason B Caboot
- b Department of Pediatrics , Pediatric Pulmonology, Madigan Army Medical Center , Tacoma , WA , USA
| | - Madeleine M Verhovsek
- c Division of Hematology and Thromboembolism , McMaster University , Hamilton , ON , Canada
| | - David P Harper
- d Department of Pediatrics , Pediatric Hematology/Oncology, Madigan Army Medical Center , Tacoma , WA , USA
| | - Melissa A Forouhar
- d Department of Pediatrics , Pediatric Hematology/Oncology, Madigan Army Medical Center , Tacoma , WA , USA
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6
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Costandi AJ, Mahmoud M. Unexpected falsely low pulse oximeter measurements in a child with hemoglobin Southampton. J Clin Anesth 2016; 33:320-1. [PMID: 27555186 DOI: 10.1016/j.jclinane.2016.04.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Andrew J Costandi
- Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA.
| | - Mohamed Mahmoud
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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7
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Hemoglobina de Köln como causa de anemia hemolítica y esplenomegalia. An Pediatr (Barc) 2013; 79:124-5. [DOI: 10.1016/j.anpedi.2013.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Revised: 01/07/2013] [Accepted: 01/08/2013] [Indexed: 11/23/2022] Open
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8
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Chan ED, Chan MM, Chan MM. Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations. Respir Med 2013; 107:789-99. [PMID: 23490227 DOI: 10.1016/j.rmed.2013.02.004] [Citation(s) in RCA: 280] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 01/19/2013] [Accepted: 02/11/2013] [Indexed: 12/14/2022]
Abstract
Pulse oximetry has revolutionized the ability to monitor oxygenation in a continuous, accurate, and non-invasive fashion. Despite its ubiquitous use, it is our impression and supported by studies that many providers do not know the basic principles behind its mechanism of function. This knowledge is important because it provides the conceptual basis of appreciating its limitations and recognizing when pulse oximeter readings may be erroneous. In this review, we discuss how pulse oximeters are able to distinguish oxygenated hemoglobin from deoxygenated hemoglobin and how they are able to recognize oxygen saturation only from the arterial compartment of blood. Based on these principles, we discuss the various conditions that can cause spurious readings and the mechanisms underlying them.
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9
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Vanhille DL, Nussenzveig RH, Glezos C, Perkins S, Agarwal AM. Best practices for use of the HEMOX analyzer in the clinical laboratory: quality control determination and choice of anticoagulant. ACTA ACUST UNITED AC 2013; 18:17-9. [PMID: 23000486 DOI: 10.1532/lh96.12001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The HEMOX Analyzer (TCS Scientific) has been used to measure the full oxygen-dissociation curve (ODC) and to calculate P(50) and the Hill coefficient. The effects of different anticoagulants on sample stability and P(50) values have not been evaluated extensively for this instrument. We characterized an artificial hemoglobin (Equil QC463) for quality control (QC) and compared P(50) values for blood samples drawn into 3 different anticoagulants (acid citrate dextrose [ACD], heparin, and EDTA). P(50) values were not stable in ACD but were stable in heparin and EDTA anticoagulants for up to 4 days. Tests with Equil QC463 showed that P(50) values were quite sensitive to small variations in buffer pH. Use of the correct anticoagulant and strict control of buffer pH are 2 parameters that need to be accounted for in best-practices use of this hemoximeter and before determining P(50).
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Affiliation(s)
- Derek L Vanhille
- Associated Regional University Pathologists Laboratories, Salt Lake City, Utah, USA
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10
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Case-control studies of novel hemoglobin anomalies as differential diagnosis in sleep apnea syndrome. Sleep Breath 2012; 17:557-63. [PMID: 22581484 DOI: 10.1007/s11325-012-0720-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 04/13/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Pulse oximetry plays an essential role in the diagnosis of sleep apnea syndrome. We discovered two novel hemoglobin anomalies, Hb Bonn and Hb Venusberg, which initially resulted in avoidable sleep disorder examinations and therapeutic consequences due to their low oxygen saturation levels as measured by pulse oximetry. METHODS Hematological as well as clinical chemical diagnosis was carried out. Hemoglobin anomalies were detected through electrophoresis, chromatography, spectrophotometry, and pulse oximetry as well as hemoglobin gene sequencing. RESULTS Hb Bonn is a novel hemoglobin mutation of the proximal α1 globin with an additional absorption maximum of the oxyhemoglobin at 668 nm. This results in pulse oximetry measurements of false low oxygen saturation due to incorrect calculations at the pulse oximetry measuring point 660 m. Hb Venusberg is a novel oxygen-affine hemoglobin mutation of the β-globin which is electrophoretically silent. Clinical symptoms include intermittent low oxygen saturation levels, cyanosis of lips and nail beds, and limited physical resistance to stress. CONCLUSIONS Hemoglobin anomalies, such as Hb Bonn and Hb Venusberg, should be included in differential diagnosis as potential causes of low oxygen saturation especially in case of nonspecific or conflicting findings.
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11
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Verhovsek M, Henderson MP, Cox G, Luo HY, Steinberg MH, Chui DH. Erratum to: Unexpectedly low pulse oximetry measurements associated with variant hemoglobins: A systematic review. Am J Hematol 2011. [DOI: 10.1002/ajh.22074] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Verhovsek M, Henderson MPA, Cox G, Luo HY, Steinberg MH, Chui DHK. Unexpectedly low pulse oximetry measurements associated with variant hemoglobins: a systematic review. Am J Hematol 2010; 85:882-5. [PMID: 20890907 DOI: 10.1002/ajh.21810] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulse oximetry estimates arterial blood oxygen saturation based on light absorbance of oxy- and deoxy-hemoglobin at 660 and 940 nm wavelengths. Patients with unexpectedly low SpO₂ often undergo cardio-pulmonary testing to ascertain the cause of their hypoxemia. However, in a subset of patients, a variant hemoglobin is responsible for low SpO₂ measurements. The extent of this problem is unclear. We performed a systematic literature review for reports of low SpO₂ associated with variant hemoglobins. We also reviewed unpublished cases from an academic hemoglobin diagnostic reference laboratory. Twenty-five publications and four unpublished cases were identified, representing 45 patients with low SpO₂ and confirmed variant hemoglobin. Fifty-seven family members of patients had confirmed or suspected variant hemoglobin. Three low oxygen affinity variant hemoglobins had concordantly low SpO₂ and SaO₂. Eleven variant hemoglobins were associated with unexpectedly low SpO₂ measurements but normal SaO₂. Hemoglobin light absorbance testing was reported in three cases, all of which showed abnormal absorption spectra between 600 and 900 nm. Seven other variant hemoglobins had decreased SpO₂, with unreported or uncertain SaO₂. Twenty-one variant hemoglobins were found to be associated with low SpO₂. Most variant hemoglobins were associated with spuriously low SpO₂. Abnormal absorption spectra explain the discrepancy between SpO₂ and SaO(2) for some variants. The differential diagnosis of possible variant hemoglobin ought to be considered in asymptomatic patients found to have unexpectedly low SpO₂. The correct diagnosis will help to spare patients from unnecessary investigations and anxiety.
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Affiliation(s)
- Madeleine Verhovsek
- Section of Hematology and Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.
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13
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Abstract
Hemoglobinopathies are diseases involving abnormalities of the structure or production of hemoglobin. Examples include sickle cell disease, the thalassemias, and rare hemoglobin variants producing cyanosis. Recent advances in the understanding of the consequences of hemoglobin dysfunction on nitric oxide signaling have led to a reassessment of the pathophysiology of sickle cell disease and thalassemia. Chronic vascular inflammation and damage is now recognized as playing an important role in disease expression. Hemoglobinopathies may present to the anesthesiologist as the primary cause of a surgical procedure, as an incidental complicating factor of a surgical patient, or with a problem arising from the disease itself. This article reviews the common types of hemoglobinopathies, presents a basic summary of the pathophysiology relevant to anesthesia, and outlines current perioperative management.
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14
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Cheung VY, Silverman JA. Hemoglobin Köln and Pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:907-909. [DOI: 10.1016/s1701-2163(16)32971-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Holbrook S, Quinn A. An unusual explanation for low oxygen saturation. Br J Anaesth 2008; 101:350-3. [DOI: 10.1093/bja/aen183] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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16
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Yodfat UA, Vaida SJ. Unexpected Falsely Low Pulse Oximeter Measurements in a Child with Hemoglobin Cheverly. Anesth Analg 2006; 103:259-60. [PMID: 16790675 DOI: 10.1213/01.ane.0000215225.62860.6a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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17
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Hurford WE, Kratz A. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 23-2004. A 50-year-old woman with low oxygen saturation. N Engl J Med 2004; 351:380-7. [PMID: 15269319 DOI: 10.1056/nejmcpc049013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- William E Hurford
- Department of Anesthesia and Critical Care, Massachusetts General Hospital and Harvard Medical School, USA
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18
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Bruns CM, Thet LA, Woodson RD, Schultz J, Hla KM. Hemoglobinopathy case finding by pulse oximetry. Am J Hematol 2003; 74:142-3. [PMID: 14508804 DOI: 10.1002/ajh.10394] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Pulse oximetry is a widely used, noninvasive instrument for monitoring oxygen saturation. Its use, however, is limited in the setting of dyshemoglobinemias. We report a case of hemoglobin Rothschild in an Asian patient diagnosed as a result of routine pulse oximetry. This case reiterates the limitations of pulse oximetry in patients with dyshemoglobinemias, while introducing its use as a case-finding tool for such conditions.
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Affiliation(s)
- Cristin M Bruns
- Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin 53792, USA.
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Kuji A, Satoh Y, Kikuchi K, Satoh K, Joh S. The anesthetic management of a patient with hemoglobin M(Iwate). Anesth Analg 2001; 93:1192-3, table of contents. [PMID: 11682395 DOI: 10.1097/00000539-200111000-00028] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPLICATIONS Pulse oximetry is now considered essential for anesthetic management. We treated a patient with hemoglobin M(Iwate), a rare inheritable hemoglobinopathy rendering pulse oximetry completely useless because of its anomalous absorption spectrum.
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Affiliation(s)
- A Kuji
- Dental Center for Special Patients, Iwate Medical University Dental Hospital, Iwate Medical University, Morioka, Japan
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20
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Hohl RJ, Sherburne AR, Feeley JE, Huisman TH, Burns CP. Low pulse oximeter-measured hemoglobin oxygen saturations with hemoglobin Cheverly. Am J Hematol 1998; 59:181-4. [PMID: 9798654 DOI: 10.1002/(sici)1096-8652(199811)59:3<181::aid-ajh1>3.0.co;2-i] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Unexpectedly low hemoglobin oxygen saturation as determined by pulse-oximeter analysis was observed in a patient who underwent an elective surgical procedure. Specific hemoglobin derivatives such as carboxyhemoglobin, methemoglobin, and reduced hemoglobin that have been described to lower pulse-oximetry determination of oxygenation were not detected. Absorbance spectra revealed the patient's hemoglobin to be different than that obtained from two normal volunteers. High-pressure liquid chromatographic analysis of the hemoglobin showed an unknown band that comprised 15% of the patient's hemoglobin. DNA sequence analysis showed a point mutation in the second nucleotide of the 45th codon of the beta-globin chain. This mutation encodes for an abnormal beta-chain (beta-45 Phe-->Ser) that has been described as hemoglobin Cheverly. Hemoglobin Cheverly is an unstable hemoglobin that has a similar mutation as the beta-42 Phe-->Ser mutation seen in hemoglobin Hammersmith. Hemoglobin Hammersmith and another unstable hemoglobin, hemoglobin Köln, have previously been described to have unexpectedly low pulse-oximeter-determined oxyhemoglobin levels. That we find hemoglobin Cheverly to result in a similar phenomenon suggests that pulse-oximeter monitoring of oxygenation status may not be appropriate for the unstable hemoglobins. Low pulse-oximeter oxygenation determinations for these hemoglobins do not appear to predict clinical hypoxemia.
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Affiliation(s)
- R J Hohl
- Department of Internal Medicine, The University of Iowa, Iowa City 52242, USA.
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Lang SA, Chang PC, Laxdal VA, Huisman TH. Haemoglobin Hammersmith precludes monitoring with conventional pulse oximetry. Can J Anaesth 1994; 41:965-8. [PMID: 8001215 DOI: 10.1007/bf03010939] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We report a case of a 15-yr-old North American Indian female with haemoglobin Hammersmith, scheduled for elective tonsillectomy, whose arterial oxygen saturation could not be reliably monitored perioperatively because of technical limitations of conventional dual wavelength pulse oximetry. The patient was chronically icteric. She had an atrial septal defect with a small L-->R shunt demonstrated by echocardiography. On arrival in the operating room pulse oximetry (Nellcor-Model N100) demonstrated a saturation of 45% whilst breathing room air. Her oxygen saturation increased to 60% whilst breathing 100% oxygen via a face mask. An arterial blood gas performed whilst breathing 100% oxygen revealed a PaO2 of 418 mmHg. Tonsillectomy was completed uneventfully under general anaesthesia. The pulse oximeter did not provide any clinically useful information throughout the case. In conclusion, conventional dual wavelength pulse oximeters cannot give an accurate estimate of oxygenation in patients with haemoglobin Hammersmith. Assessment of oxygenation in these patients requires alternative monitoring techniques.
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Affiliation(s)
- S A Lang
- Department of Anaesthesia, Royal University Hospital, Saskatoon, Saskatchewan, Canada
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