• Moritz Flick, Christina Vokuhl, Alina Bergholz, Kristina Boutchkova, Julia Y Nicklas, and Bernd Saugel.
• Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
• J Clin Monit Comput. 2025 Feb 7.

AbstractThe "Cellular Oxygen METabolism" (COMET) system (Photonics Healthcare, Utrecht, The Netherlands) non-invasively measures mitochondrial oxygen tension (mitoPO2) in the skin. The effects of general anesthesia and major non-cardiac surgery on mitoPO2 remain unknown. In this pre-planned pilot substudy of the "Intraoperative blood pressure Management based on the individual blood PRessure profile: impact on postOperatiVE organ function" (IMPROVE) trial, we measured mitoPO2 from induction of general anesthesia until the end of surgery in 19 major non-cardiac surgery patients (10 assigned to personalized and 9 to routine intraoperative arterial pressure management). In the overall cohort, the median (25th to 75th percentile) preoperative awake mitoPO2 was 63 (53 to 82) mmHg and mitoPO2 after induction of general anesthesia was 42 (35 to 59) mmHg. The intraoperative average mitoPO2 was 39 (30 to 50) mmHg. Thirteen patients (68%) had intraoperative mitoPO2 values below 20 mmHg and the median percentage of surgical time with mitoPO2 < 20 mmHg was 17 (0 to 31)%. MitoPO2 was weakly correlated with mean arterial pressure (repeated measures correlation (rrm(n); rrm(984) = 0.26, 95% confidence interval 0.20 to 0.32; P < 0.001), but not meaningfully with heart rate (rrm(984) = -0.05, 95% confidence interval -0.11 to 0.01; P = 0.117). There was no important difference in intraoperative average mitoPO2 between patients assigned to personalized or to routine intraoperative arterial pressure management (P = 0.653). MitoPO2 under general anesthesia was about a quarter lower than preoperative awake mitoPO2, substantially fluctuated during major non-cardiac surgery, and transiently decreased below 20 mmHg in about two-thirds of the patients. Personalized - compared to routine - intraoperative arterial pressure management did not increase intraoperative mitoPO2. Whether intraoperative decreases in mitoPO2 are clinically meaningful warrants further investigation.© 2025. The Author(s).

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