Effects of prolonged ischemia on human skeletal muscle microcirculation as assessed by near-infrared spectroscopy.

Abstract

Near-infrared spectroscopy (NIRS) has been used to detect in vivo microvascular alterations by means of a vascular occlusion test. We sought to analyse by NIRS the microcirculatory profile of patients undergoing prolonged tourniquet-induced bloodless condition for extremity surgery, and compare the results with time of ischemia and comorbidities. We conducted a prospective observational study on 42 patients undergoing upper limb surgery. Regional anaesthesia was achieved and ischemia was induced by a tourniquet cuffed at 250mmHg. The probe of a NIRS monitor (InSpectra 325, Hutchiston, USA) was placed on the brachial muscle, and muscle oxygen saturation (StO2) was recorded continuously before anaesthesia, during and after surgery. The following variables were recorded: baseline StO2, StO2 desaturation slope during occlusion (dSlope, units/s), resaturation rate following ischemia (RR, units/s), hyperaemic peak (peak, units), and duration of the hyperaemic period following ischemia (hyperaemic time, s). Values of dSlope were similar among all patients. RR and hyperaemic time were significantly correlated with the duration of ischemia, but not with comorbidities [p=0.007 CI (-35.64 to -13.1), and p<0.001 CI (0.049-0.159), respectively]. Grouping patients by duration of ischemia (30, 60, or 90min), we found a significant decrease in RR after 60 and 90min (p<0.001 and p=0.03, respectively). Hyperaemic peak was lower in the 90min group (83.9±6.8 vs. 91.2±5.7%, p=0.02) whereas the hyperaemic time was significantly increased (595±136 vs. 429±107min, p<0.001). Alterations of skeletal muscle microcirculation were correlated with the duration of ischemia, but not with comorbidities. We observed an initial impairment of the microcirculatory recovery at 90min of ischemia.