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 puke oximeters cannot give an accurate estimate of oxygenation in patients with haemoglobin Hammersmith. Assessment of oxygenation in these patients requires alternative monitoring techniques.
Résumé
Nous rapportons le cas d’une autochtone nord-américaine de 15 ans, porteuse d’hémoglobine Hammersmith, programmée pour une amygdalectomie et dont la saturation en oxygène ne peut être mesurée avec fiabilité à cause des limitations de la technique habituelle de l’oxymétrie puisée à deux longueurs d’ondes. La patiente est une ictérique chronique. L’échographie a révélé une communication interauriculaire avec un léger shunt d-g. A sont arrivée en salle d’opération, l’oxymétre (Nellcor-Model N100) affiche une saturation à 45% en air. La saturation sous oxygène à 100% par masque facial augmente à 60%. Un gaz artériel réalisé sous oxygène à 100% montre une PaO2 de 418 mmHg. L’amygdalectomie est complétée sans incident sous anesthésie générale. L’oxymétrie puisée ne procure pas d’autres renseignements cliniques pertinents. Pour conclure, l’oxymétrie puisée à double longueur d’ondes ne peut évaluer avec précision l’oxygénation en présence d’hémoglobine d’Hammersmith. L’évaluation de l’oxygénation dans ces cas nécessite des techniques de monitorage différentes.
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Lang, S.A., Chang, P.C., Laxdal, V.A. et al. Haemoglobin Hammersmith precludes monitoring with conventional pulse oximetry. Can J Anaesth 41, 965–968 (1994). https://doi.org/10.1007/BF03010939
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DOI: https://doi.org/10.1007/BF03010939