Novel Use of Pulse Oximetry with an Oral Airway and a Disposable Pulse Oximetry Sensor in a Critically Ill Burn Patient During Debridement and Grafting
Bret D. Alvis Department Of Anesthesiology, Vanderbilt University Medical Center, Nashville, United States
Published on: 2018-09-24
Purpose: Pulse oximetry is a standard American Society of Anesthesiologists (ASA) monitor. At times, monitoring sites will not be available due to reasons such as burn, crush, amputation, poor perfusion or presence in a surgical field. In the case presented here, all known monitoring sites were eliminated resulting in the need to obtain an oral pulse oximetry measurement from the hard and soft palate. Case History: A 45-year-old male suffered critical burns from a propane tank explosion, sustaining 80% total body surface area (TBSA) full-thickness burns. During surgical debridement, the pulse oximetry sensor had to be moved so that the operation could continue. No traditional site was available; therefore, the only remaining option was to obtain oxygen hemoglobin saturation measurements from the mouth using an oral airway and a disposable pulse oximetry sensor. Comments: In situations where no other pulse oximetry sites are available, oral airway oximetry may be attempted while observing other trends in oxygenation and ventilation throughout the anesthetic.
Pulse oximetry is a standard ASA monitor that is required for all patients undergoing any anestheti. Both traditional transmissive pulse oximetry (placed on the ear, finger or toe), and reflectance forehead oximetry are widely available to most anesthesia providers. Also, available, in some hospital settings, is esophageal oximetry—not an option at the institution of this case report. The two common types of pulse oximetry are transmissive and reflectance. A transmissive pulse oximeter uses spectrophotometry to measure light absorption at two wavelengths: red light @ 660nm and infrared light @ 940nm. Since oxygenated and deoxygenated blood absorb light differently, the communication of these diodes through tissue can be used to create a ratio that appears as a waveform and an oxygen saturation percentage (SpO2 ). Reflectance forehead oximetry measures the scattered transmission of light through tissues at multiple wavelengths to determine the differences in the oxygenated and deoxygenated hemoglobin; also appearing as a waveform and an oxygen saturation percentage.