Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study
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 coh...
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| Format: | Article |
| Language: | English |
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BMC
2019-05-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-019-0740-8 |
| _version_ | 1819063044041342976 |
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| author | Liang Lin Gang Li Jinlei Li Lingzhong Meng |
| author_facet | Liang Lin Gang Li Jinlei Li Lingzhong Meng |
| author_sort | Liang Lin |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-21T15:08:25Z |
| format | Article |
| id | doaj.art-ec1154dc428f422fb949389f4adc71b2 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-21T15:08:25Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-ec1154dc428f422fb949389f4adc71b22022-12-21T18:59:21ZengBMCBMC Anesthesiology1471-22532019-05-011911710.1186/s12871-019-0740-8Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational studyLiang Lin0Gang Li1Jinlei Li2Lingzhong Meng3Department of Anesthesiology, The First Affiliated Hospital, Xiamen UniversityDepartment of Anesthesiology, Peking University Third HospitalDepartment of Anesthesiology, Yale University School of MedicineDepartment of Anesthesiology, Yale University School of MedicineAbstract 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.http://link.springer.com/article/10.1186/s12871-019-0740-8Tissue oxygenationTourniquetIschemiaHypoxia |
| spellingShingle | Liang Lin Gang Li Jinlei Li Lingzhong Meng Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study BMC Anesthesiology Tissue oxygenation Tourniquet Ischemia Hypoxia |
| title | Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study |
| title_full | Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study |
| title_fullStr | Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study |
| title_full_unstemmed | Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study |
| title_short | Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study |
| title_sort | tourniquet induced tissue hypoxia characterized by near infrared spectroscopy during ankle surgery an observational study |
| topic | Tissue oxygenation Tourniquet Ischemia Hypoxia |
| url | http://link.springer.com/article/10.1186/s12871-019-0740-8 |
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