Acceptable Intra-aortic Balloon Occlusion Duration Affecting the Regional Saturation Oxygen of Lower Limbs Using Near-infrared Spectroscopy for Abnormally Adherent Placentation

Abstract

Objective: To investigate the utility of regional saturation oxygen (rSO2) using near-infrared spectroscopy (NIRS) in the lower limbs and to estimate the safe occlusion duration in patients with abnormally adherent placentation who underwent intra-aortic balloon occlusion (IABO) during a cesarean hysterectomy by comparing them with infrarenal aortic clamping. Methods: The researchers classified 15 lower limbs of patients with abnormally adherent placentation with IABO during a cesarean hysterectomy as the balloon group and 20 lower limbs of patients with cross-clamping on the infrarenal aorta during the aneurysmal repair as the clamping group. The rSO2 measurement of the limbs was performed using a near-infrared spectrometer. In addition, the aortic occlusion duration, rSO2 before and during occlusion, and after blood resumption were analyzed. Results: Continuous rSO2 measurement was possible in all patients. The median aortic occlusion durations in the balloon and clamping groups were 68 and 92.5 min, and the median minimum rSO2 during occlusion was 60% and 17.5%, respectively. The clamping group was found to have stronger occlusion for a longer time than the balloon group. No complications associated with aortic occlusion were observed in both groups. Conclusions: rSO2 measurement using a near-infrared spectrometer effectively monitors lower-limb blood flow during IABO in patients with abnormally adherent placentation. An IABO duration of approximately 90 min was believed to be relatively acceptable in a cesarean hysterectomy under heparin administration.