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

  • 1Department of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.


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.


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