Mark Wefers Bettink

Chapter 8 160 a rise in serum lactate only became evident in the postoperative phase. These findings suggests that mitoPO 2 around and below 20 mmHg during a longer period of time can be associated with cellular hypoxia and systemic signs of anaerobic metabolism. The relationship between increased serum lactate and low mitoPO 2 has also been observed by Römers et al 26 . Since increased serum lactate is associated with adverse outcome, we hypothesize that additional mitoPO2 can be of added value during surgery 27 . Because many factors are involved in maintaining an adequate cellular oxygenation, it seem wise to not base perioperative hemodynamic, blood transfusion and fluid therapy strategies during complex surgery on standard intraoperative parameters alone. Therefore, we suggest to use additional mitochondrial oxygenation and microvascular flow measurements in major surgery and in blood transfusion management to prevent cellular hypoxia and organ damage to improve long-term outcome 6,7,28 . The added value of the mitochondrial oxygenation measurements during major surgery must be demonstrated further in future studies. The present study is a first step towards evidence based monitoring of mitochondrial oxygenation in the operation theatre. This study shows the feasibility and applicability of measuring mitoPO 2 in the operating theatre using the COMET ® monitor. MitoPO 2 measurement remains feasible even during long-lasting surgery.