Exhaled methane as an early non-invasive perfusion marker: relation with perioperative blood loss during elective large joint replacement surgery

  • Laszlo Jozsef Kisvari University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary https://orcid.org/0009-0001-9684-1079
  • Zoltan Peter Meszaros University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary https://orcid.org/0009-0006-4157-9962
  • Anna Szabo University of Szeged, Faculty of Natural Sciences and Informatics, Institute of Physics, Department of Optics and Quantum Electronics, Hungary
  • Zoltan Bozoki, Dr. University of Szeged, Faculty of Natural Sciences and Informatics, Institute of Physics, Department of Optics and Quantum Electronics, Hungary https://orcid.org/0000-0003-3638-9524
  • Lilla Sandor, MD University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary https://orcid.org/0000-0002-0530-763X
  • Tibor Donka, MD University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary https://orcid.org/0000-0003-3793-9647
  • Attila Fetter University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary
  • Balazs Ocsko University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary
  • Petr Machac, MUDr University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics
  • Laszlo Torok, MD Habil. PhD University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary https://orcid.org/0000-0001-9287-524X
  • Petra Hartmann, MD Habil. PhD University of Szeged Szent-Györgyi Albert Clinical Center Department of Traumatology and Orthopaedics, Hungary https://orcid.org/0000-0002-4746-9792
DOI: https://doi.org/10.21755/MTO.2025.068.0104.004
Keywords: Arthroplasty, replacement, Breath Tests – Methods, Exhalation – Physiology, Hemorrhage – Complications, Mesenteric artery, superior, Methane – Analysis

Abstract

In surgical procedures associated with major blood loss, early recognition of perfusion insufficiency is essential, as hypovolemic shock resulting from hemorrhage is one of the most common yet preventable causes of death. Currently used hemodynamic parameters, such as blood pressure and heart rate, have limited predictive value. Measurement of exhaled methane (CH₄) concentration represents a novel approach for monitoring mesenteric perfusion, since the primary physiological response to blood loss is a reduction in blood flow within the superior mesenteric artery (SMA). The intestinal segments supplied by the SMA harbor the microbiota that constitute the primary source of exhaled methane. The aim of this study was to investigate changes in exhaled CH₄ concentration in patients undergoing major joint endoprosthesis implantation. A prospective study was conducted between September 1 and October 31, 2024, at the Department of Traumatology and Orthopedics, University of Szeged. Exhaled CH₄ concentrations were measured preoperatively and postoperatively in patients undergoing major joint endoprosthesis implantation. Measurements were performed using a photoacoustic spectroscopy (PAS) device. In addition, intraoperative blood loss, administered fluids, and vital parameters were recorded based on anesthesiology documentation. A total of 25 patients were included (56% male, 44% female; mean age: 66.12 ± 9.72 years). Thirty-two percent of the patients were methane producers. Mean intraoperative blood loss was 262 ± 159.61 mL. The administered crystalloid volume was 747.83 ± 307.29 mL, while the colloid volume was 521.42 ± 80.18 mL. A moderate positive correlation was observed between changes in exhaled CH₄ concentration and the extent of blood loss (r = 0.57); however, this association did not reach statistical significance (p = 0.1386). Our results are limited by the low level of surgical blood loss and the small sample size. If larger studies confirm these results, real-time monitoring of CH₄ could be useful in the early detection of blood loss and could improve the quality of emergency and surgical care.

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Published
2025-12-27
Issue
Vol. 68 No. 1-4 (2025)
Section
Original article