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Observational Study
, 19 (1), 70

Tourniquet-induced Tissue Hypoxia Characterized by Near-Infrared Spectroscopy During Ankle Surgery: An Observational Study

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Observational Study

Tourniquet-induced Tissue Hypoxia Characterized by Near-Infrared Spectroscopy During Ankle Surgery: An Observational Study

Liang Lin et al. BMC Anesthesiol.

Abstract

Background: Pneumatic tourniquet inflation during extremity surgery leads to profound and prolonged tissue ischemia. Its effect on tissue oxygenation is inadequately studied.

Methods: Patients undergoing elective ankle surgery with tourniquet application participated in this observational cohort study. Somatic and cerebral tissue oxygen saturation (SstO2 and SctO2) were monitored using tissue near-infrared spectroscopy. Oxygenation was monitored distally (SstO2-distal) and proximally to the tourniquet, on the contralateral leg, and the forehead (a total of 4 tissue beds). Tissue oxygenation at different time points was compared. The magnitude, duration, and load (product of magnitude and duration) of tissue desaturation during tourniquet inflation were correlated with tissue resaturation and hypersaturation after tourniquet deflation.

Results: Data of 26 patients were analyzed. The tourniquet inflation time was 120 ± 31 mins. Following a rapid desaturation from 77 ± 8% pre-inflation to 38 ± 20% 10 mins post-inflation, SstO2-distal slowly and continuously desaturated and reach the nadir (16 ± 11%) toward the end of inflation. After deflation, SstO2-distal rapidly resaturated from 16 ± 11% to 91 ± 5% (i.e., hypersaturation); SstO2 monitored proximally to the tourniquet and on contralateral leg had significant but small desaturation (~ 2-3%, p < 0.001); in contrast, SctO2 remained stable. The desaturation load had a significant correlation with resaturation magnitude (p < 0.001); while the desaturation duration had a significant correlation with hypersaturation magnitude (p = 0.04).

Conclusions: Tissue dys-oxygenation following tourniquet application can be reliably monitored using tissue oximetry. Its outcome significance remains to be determined.

Keywords: Hypoxia; Ischemia; Tissue oxygenation; Tourniquet.

Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Internal Review Board at Yale University and patients gave written informed consent for study participation.

Consent for publication

Not applicable.

Competing interests

Lingzhong Meng is a consultant to CAS Medical Systems, Inc. The other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Group mean and standard deviation of somatic tissue oxygen saturation (SstO2) monitored distal (SstO2-distal) and proximal (SstO2-prox) to the tourniquet and on the contralateral leg (SstO2-contra) and cerebral tissue oxygen saturation (SctO2) monitored on the forehead at different time points. Tend = time point at the end of tourniquet inflation; Tpost = time point 3–5 min after tourniquet deflation
Fig. 2
Fig. 2
Real-time tracing of somatic tissue oxygen saturation (SstO2) monitored distal (SstO2-distal) and proximal (SstO2-prox) to the tourniquet and on the contralateral leg (SstO2-contra) and cerebral tissue oxygen saturation (SctO2) monitored on the forehead in a 21-year old college student

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References

    1. Mars M, Gregory MA. A histometric analysis of skeletal myofibers following 90 min of tourniquet ischemia and reperfusion. J Surg Res. 1991;50(2):191–195. doi: 10.1016/0022-4804(91)90246-I. - DOI - PubMed
    1. Hogan MC, Kurdak SS, Arthur PG. Effect of gradual reduction in O2 delivery on intracellular homeostasis in contracting skeletal muscle. J Appl Physiol (1985) 1996;80(4):1313–1321. doi: 10.1152/jappl.1996.80.4.1313. - DOI - PubMed
    1. Meng L, Gruenbaum SE, Dai F, Wang T. Physiology, intervention, and outcome: three critical questions about cerebral tissue oxygen saturation monitoring. Minerva Anestesiol. 2018;84(5):599–614. - PubMed
    1. Sanfilippo F, Serena G, Corredor C, Benedetto U, Maybauer MO, Al-Subaie N, Madden B, Oddo M, Cecconi M. Cerebral oximetry and return of spontaneous circulation after cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2015;94:67–72. doi: 10.1016/j.resuscitation.2015.06.023. - DOI - PubMed
    1. Meng L, Xiao J, Gudelunas K, Yu Z, Zhong Z, Hu X. Association of intraoperative cerebral and muscular tissue oxygen saturation with postoperative complications and length of hospital stay after major spine surgery: an observational study. Br J Anaesth. 2017;118(4):551–562. doi: 10.1093/bja/aex008. - DOI - PubMed

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