{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:49:32Z","timestamp":1782107372010,"version":"3.54.5"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intraoperative cerebral desaturation has been associated with postoperative neurocognitive complications and may represent a potentially modifiable perioperative risk factor. The Pringle maneuver, or intermittent portal triad clamping, is routinely used to minimize blood loss during low-central-venous-pressure (LCVP) hepatectomy; however, its real-time relationship with cerebral oxygenation remains insufficiently characterized. We report a case providing high-resolution, time-locked documentation of abrupt bilateral regional cerebral oxygen saturation (rSO\u2082) decline during repeated intermittent hepatic inflow occlusion under LCVP conditions, followed by transient CAM-positive postoperative delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 51-year-old female underwent elective right hepatectomy for hepatocellular carcinoma under low-central-venous-pressure (CVP\u202f&amp;lt;\u202f5\u202fcm H\u2082O) anesthesia. Bilateral rSO\u2082 was continuously monitored using near-infrared spectroscopy (NIRS) during eight cycles of intermittent Pringle maneuver (10\u201315\u202fmin occlusion\/5\u202fmin reperfusion). rSO\u2082 showed a progressive downward trend across repeated clamping cycles, reaching a nadir of 33% on the left and 30% on the right 6\u202fmin into the eighth occlusion, coinciding with a CVP decrease to 0.9\u202fcm H\u2082O despite MAP remaining above 65\u202fmmHg. The patient developed transient CAM-positive, predominantly hypoactive postoperative delirium from POD 1 to POD 3, documented during the morning assessments on POD 1 and POD 2 and during the evening assessment on POD 3. The delirium resolved by POD 4 without pharmacological treatment. Structured follow-up at 1\u202fmonth revealed subtle impairments in executive function and episodic memory (MoCA-Basic 25\/30), which normalized to baseline (28\/30) at the 3-month assessment. Evaluations at 6\u202fmonths and 1\u202fyear demonstrated sustained neurocognitive recovery with no functional deficits or oncological recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case suggests that intermittent portal triad clamping under LCVP conditions may be associated with clinically important cerebral desaturation, even when conventional mean arterial pressure targets appear acceptable. The observation highlights the limitation of relying solely on systemic arterial pressure to infer cerebral oxygenation during high-risk hepatectomy. NIRS may serve as a useful adjunctive monitor for detecting otherwise unrecognized cerebral desaturation and may help guide timely multidisciplinary responses. However, the relationship between intraoperative cerebral desaturation and postoperative delirium in this case should be interpreted as hypothesis-generating rather than causal.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1880040","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T05:40:17Z","timestamp":1782106817000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative cerebral desaturation during low-central-venous-pressure hepatectomy with intermittent Pringle maneuver: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Yan","family":"Wei","sequence":"first","affiliation":[{"name":"The First School of Clinical Medicine of Lanzhou University","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqin","family":"Mi","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine of Lanzhou University","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengfang","family":"Qi","sequence":"additional","affiliation":[{"name":"The First School of Clinical Medicine of Lanzhou University","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yatao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Operation, First Hospital of Lanzhou University","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaohui","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Operation, First Hospital of Lanzhou University","place":["Lanzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1016\/j.jss.2013.04.072","article-title":"Specialization and utilization after hepatectomy in academic medical centers","volume":"185","author":"Shaw","year":"2013","journal-title":"J Surg Res"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1007\/s00423-016-1512-2","article-title":"Mortality-related risk factors and long-term survival after 4460 liver resections in Sweden-a population-based study","volume":"402","author":"Gilg","year":"2017","journal-title":"Langenbeck's Arch Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1016\/s1091-255x(00)80052-9","article-title":"Hepatic resection using intermittent vascular inflow occlusion and low central venous pressure anesthesia improves morbidity and mortality","volume":"4","author":"Chen","year":"2000","journal-title":"J Gastrointest Surg"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"311","DOI":"10.21037\/gs.2020.03.07","article-title":"The efficacy and safety of controlled low central venous pressure for liver resection: a systematic review and meta-analysis","volume":"9","author":"Wang","year":"2020","journal-title":"Gland Surg"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"371","DOI":"10.4097\/kja.21414","article-title":"Combined cerebral and somatic near-infrared spectroscopy oximetry monitoring during liver surgery: an observational and non-interventional study","volume":"75","author":"Collin","year":"2022","journal-title":"Korean J Anesthesiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1097\/EJA.0000000000001876","article-title":"Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients","volume":"41","author":"Aldecoa","year":"2024","journal-title":"Eur J Anaesthesiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: the confusion assessment method. 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