Abstract
BackgroundIschemic or volatile anesthetic preconditioning is defined as tissue protection from impending ischemic cell damage by repetitive short periods of tissue exposure to ischemia or volatile anesthetics. Objective of this study was to elucidate, if ischemic preconditioning and pharmacological preconditioning with sevoflurane have effects on muscle tissue oxygen saturation in patients undergoing surgical revascularization of the lower limb.MethodsIn this prospective randomized pilot study ischemic and pharmacological (sevoflurane) preconditioning was performed in 40 patients with lower limb arterial occlusive disease undergoing surgical revascularization. Sevoflurane preconditioning was performed in one group (N = 20) by repetitive application of sevoflurane for six minutes interspersed by six minutes of washout. Thereafter, ischemic preconditioning was performed in all patients (N = 40) by repetitive clamping of the femoral artery for six minutes interspersed by six minutes of reperfusion. The effect of both procedures on leg muscle tissue oxygen saturation (rSO2) was measured by near-infrared spectroscopy during both procedures and during surgery and reperfusion (INVOS® 5100C Oxymeter with Small Adult SomaSensor® SAFB-SM, Somanetics, Troy, Michigan, USA).ResultsRepetitive clamping and reperfusion of the femoral artery resulted in significant cyclic decrease and increase of muscle rSO2 (p < 0.0001). Pharmacological preconditioning with sevoflurane resulted in a faster and higher increase of rSO2 during postoperative reperfusion (Maximal 111% baseline ± 20 versus 103% baseline ± 14, p = 0.008) consistent with an additional effect of pharmacological preconditioning on leg perfusion.ConclusionsIschemic preconditioning of lower limb muscle tissue and pharmacological preconditioning with sevoflurane have an effect on tissue oxygenation in patients with lower limb occlusive arterial disease.Trial registrationThe trial has been registrated at http://www.ClinicalTrial.gov, Trial Number: NCT02038062 at 14 January 2014.
Highlights
Ischemic or volatile anesthetic preconditioning is defined as tissue protection from impending ischemic cell damage by repetitive short periods of tissue exposure to ischemia or volatile anesthetics
Ischemic preconditioning (IPC) is defined as protection from ischemic cell damage by preceding repetitive short periods of ischemia followed by reperfusion [2]
Differences between groups are not significant (“IPC + sevoflurane” = patients with sevoflurane preconditioning before ischemic preconditioning (IPC), “IPC” = patients without sevoflurane preconditioning before ischemic preconditioning)
Summary
Ischemic or volatile anesthetic preconditioning is defined as tissue protection from impending ischemic cell damage by repetitive short periods of tissue exposure to ischemia or volatile anesthetics. Ischemic preconditioning (IPC) is defined as protection from ischemic cell damage by preceding repetitive short periods of ischemia followed by reperfusion [2]. IPC may be achieved by repetitive ischemia of an organ or limb remote from the protected tissue (Remote ischemic preconditioning, RIPC) [3]. IPC by repetitive clamping of the femoral artery before surgery may protect lower limb tissue from ischemic and reperfusion injury during and after clamping of the femoral artery for vascular surgery and may protect remote organs as the heart by RIPC. Patients with limb ischemia due to occlusive arterial disease develop collateral vessels to the femoral artery. Due to the great variability of these vessels bypassing the femoral artery, it remains unclear if effective ischemia and reperfusion cycles can be achieved by clamping the femoral artery [5]
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