Abstract
BackgroundPneumatic tourniquet inflation during extremity surgery leads to profound and prolonged tissue ischemia. Its effect on tissue oxygenation is inadequately studied.MethodsPatients 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.ResultsData 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).ConclusionsTissue dys-oxygenation following tourniquet application can be reliably monitored using tissue oximetry. Its outcome significance remains to be determined.
Highlights
Pneumatic tourniquet inflation during extremity surgery leads to profound and prolonged tissue ischemia
A pneumatic tourniquet is commonly employed during extremity surgery to reduce blood loss and facilitate the surgeon’s operation
Tourniquet inflation led to a rapid decrease of Somatic tissue oxygen saturation (SstO2)-distal
Summary
Pneumatic tourniquet inflation during extremity surgery leads to profound and prolonged tissue ischemia. Lin et al BMC Anesthesiology (2019) 19:70 patients having surgery [3] and cardiac arrest [4]; in contrast, the clinical application of somatic tissue oxygen saturation (SstO2), monitored at a peripheral location, is relatively new [5, 6]. The goal of this prospective cohort study was to characterize the tissue dys-oxygenation related to tourniquet application during ankle surgery. The secondary objective was to correlate parameters derived during tourniquet inflation with parameters derived following tourniquet deflation to explore the potential direction for future research
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