Measurement of tissue oxygen saturation during arthroscopic surgery of knee with a tourniquet (original) (raw)
Related papers
Acta anaesthesiologica Belgica, 2007
We studied the effects of anesthesia with propofol or sevoflurane on the production of free oxygen radicals during total knee arthroplasty performed with the use of an ischemic tourniquet by measuring the levels of malondialdehyde (MDA). We studied two groups of patients (20 patients in each group) who underwent total knee arthroplasty. To maintain anesthesia we delivered 66% nitrous oxide plus sevoflurane or propofol. Blood samples for the determination of the MDA levels were drawn before the application of the ischemic tourniquet and 5 and 30 minutes after its release. There were no differences between groups in regard to age, weight and duration of the tourniquet application. MDA levels decreased significantly in the propofol group 30 minutes after the release of the tourniquet (1.7 micromol litre(-1) vs 1.57 micromol litre(-1), Friedman's ANOVA, P = 0.007). In contrast, there was a small rise of the MDA levels in the sevoflurane group (1.82 micromol litre(-1) vs 1.96 micromo...
The Hemodynamic and Metabolic Effects of Tourniquet Application During Knee Surgery
Anesthesia & Analgesia, 2000
We evaluated the effects of tourniquet application on the cardiovascular system and metabolism in 10 young men undergoing knee surgery with general anesthesia. The duration of inflation was from 75 to 108 min. Heart rate, mean arterial pressure, cardiac index (CI) by pulse contour method, and systemic vascular resistance were measured before, during, and after tourniquet inflation. pH, Pao 2 , Paco 2 , and lactate blood concentrations were also measured. V o 2 and V co 2 were assessed every minute from tracheal intubation up to 15 min after tourniquet deflation and V o 2 in excess of the basal value over the 15 min after deflation (V o 2 exc) was calculated. Mean arterial pressure increased 26% (P Ͻ 0.05) during inflation and returned to basal values after deflation. CI did not change immediately after inflation; although, thereafter, it increased 18% (P Ͻ 0.05). Five minutes after deflation, CI further increased to a value 40% higher than the basal value. Therefore, systemic vascular resistance increased 20% suddenly after inflation (P Ͻ 0.05) and decreased 18% after deflation (P Ͻ 0.05). V o 2 and V co 2 remained stable during inflation and increased (P Ͻ 0.05) after deflation. V o 2 exc depended on duration of tourniquet inflation time (Tisch) (P Ͻ 0.05). After deflation, Paco 2 and lactate increased (P Ͻ 0.05) while Tisch increased. We conclude that tourniquet application induces modifications of the cardiovascular system and metabolism, which depend on tourniquet phase and on Tisch. Whether these modifications could be relevant in patients with poor physical conditions is not known.
Journal of Anesthesia & Clinical Research, 2014
The study prospectively compared the kinetics of post-deflation tissue oxygen recovery between tourniquets with distinct inflation pressures. Forty knee arthroscopy patients were randomized into standard (350 mmHg) or reduced inflation pressure groups. In the latter group, arterial occlusion pressure was calculated according to a formula [(SBP+10)/K TP ], where SBP is the systolic blood pressure and K TP is the tissue padding coefficient based on limb circumference; a safety margin of 40-80 mmHg was added based on occlusion pressure. Pulse oximeter probes were applied to operative and nonoperative second toes and connected to a vital signs monitor. After tourniquet inflation, arthroscopy, and cuff deflation, arterial oxygen saturation was measured and recorded by the monitor every minute for 15 minutes. Standard inflation pressure group tourniquet time averaged 50 minutes at 350 mmHg; the respective values in the reduced pressure group were 51 minutes and 256 mmHg. Oxygen saturation recovery in the studied extremity was immediate after cuff deflation, with a transient drop at 5 minutes and recovery at 13 minutes. The drop was later and lesser in the reduced pressure group. In the control extremity, a transient decrease occurred at 3 minutes, with recovery at 12 minutes. The dip was again less pronounced in the reduced pressure group. In the reduced pressure group bleeding into the arthroscopic field was noted in multiple procedures. Enrollment was stopped early, as the impaired visualization was a safety concern. Unlike in the standard inflation pressure group, a bloodless arthroscopy field was not maintained in the reduced pressure group. The kinetics of post-deflation oxygen saturation recovery was not significantly different between the two groups; however, a transient decrease occurred in post-deflation oxygen saturation in both the operative and nonoperative limbs. This suggests that elective tourniquet use can have systemic effects post-cuff deflation, which warrants further investigation.
Acta Anaesthesiologica Belgica
Background : During orthopedic surgery, the use of a pneumatic tourniquet results in side effects secondary to ischemia-reperfusion phenomena. We tested the hypothesis that total knee arthroplasty with a tourniquet is associated with increase in plasma concentrations of biomarkers of neutrophil activation and endothelial injury. The second aim was to compare these changes during spinal or general inhalational anesthesia. Methods : 40 adult ASA I-II patients scheduled for total knee arthroplasty with a tourniquet under spinal or sevoflurane anesthesia were included. Venous blood samples were collected before surgery, 1 h, 3 h, and 24 h after tourniquet deflation. To assess neutrophil activation, plasma concentrations of total and active fractions of myeloperoxidase, as well as elastase concentrations and proteolytic activity were measured. Endothelial injury was assessed by measurement of plasma concentrations of syndecan-1, soluble thrombomodulin, soluble E-selectin, and vascular en...
Medical Devices: Evidence and Research
Background: Infrared thermal imaging is a non-invasive technique capable of detecting changes in temperature that could ultimately signify changes in blood supply. Flir One is a smartphone-based thermal camera, working by a downloadable application, capable of detecting the limb temperature through a non-contact method using infrared thermography technology. Using the Flir One camera, we will assess the lower limb reperfusion profile following the tourniquet release post total knee arthroplasty (TKA). Methods: A prospective study included 46 patients who underwent primary TKA. We used the (Flir One Gen 3) thermographic camera to capture images at ankle joint preoperatively, and at 1, 10, and 20 minutes post tourniquet release on operation side. The contralateral ankle stands as control. Results: The mean preoperative temperature (in Celsius) of ankle control side and operated side were 33.03 (SD=1.65) and 33.26 (SD=1.42), respectively. The mean ankle temperature on operation side was 19.73 (SD=2.85), 30.49 (SD=2), and 32.43 (SD=1.31) at 1, 10, and 20 minutes post tourniquet release, respectively, while the control side showed a mean temperature of 32.85 (SD=1.42), 32.84 (SD=0.91), and 33.15 (SD=0.95) at the same time intervals. There was a significant statistical difference between both ankle temperatures at 1 and 10 minutes (P=0.00 for each time). At 20 minutes, 37 ankles (80.4%) at operation side reached a temperature level similar but below the level of control side; however, the difference was not significant (P=0.692). Conclusion: Infrared thermography using the smartphone-connected camera is a simple, non-invasive, feasible, and reliable technology. It provides an objective measure to assess the perfusion status of the limbs. In TKA, the distal limb will reach full reperfusion status after approximately 20 minutes of tourniquet release.
Open Journal of Anesthesiology, 2021
Oxidative stress occurs in the organism with ischemia due to tourniquet use and subsequent reperfusion. Oxidative stress increases postoperative morbidity. Some Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) perform their anti-inflammatory effects in part by binding or inhibiting their formation of active oxygen radicals at the site of inflammation. In this study, we aimed to evaluate the effect of IV ibuprofen on ischemia-reperfusion injury (IRI) in patients undergoing total knee arthroplasty over oxidative stress parameters. The patients were randomly divided into two groups. Each patient's protocol number, age, sex, body mass index (BMI), additional disease, drug use, tourniquet time, hemoglobin value, additional analgesic requirement and application, adverse reaction development on the first postoperative day were recorded in the research follow-up form. Both groups of patients; before anesthesia, 45 minutes after tourniquet application, 5 minutes after tourniquet lowering, 20 minutes after tourniquet lowering and at 24th-hour post-op; TOS, TAS, paraoxonase, arylesterase, myeloperoxidase, catalase, ceruloplasmin, albumin, IMA, thiol-disulfide balance tests were studied. Statistical analysis of test results was performed. We observed that antioxidants decreased and oxidants increased on the first postoperative day in both groups in patients who underwent total knee arthroplasty. The decrease in antioxidant parameters was higher in IV ibuprofen doses compared to the control group in the case group; these doses indicate that the drug adversely affects the organism in the fight against oxidative stress, which is an undesirable effect. To evaluate this negative effect of IV ibuprofen which
BioMed Research International, 2014
Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia ( 1 ), 30 min after tourniquet inflation ( 2 ), immediately before ( 3 ), and 5 min ( 4 ), 15 min ( 5 ), 30 min ( 6 ), 1 h ( 7 ), 2 h ( 8 ), and 6 h ( 9 ) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at 2 -9 and 2 -7 . MDA levels in Group T and Group I were significantly lower than those in Group S at 2 -8 and 2 -9 . IMA levels in Group T were significantly lower than those in Group S at 2 -7 . Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.
Journal of Clinical Anesthesia, 2014
Study Objective: To determine the effects of a small-dose ketamine-propofol combination used for sedation during spinal anesthesia on tourniquet-induced ischemia-reperfusion injury. Study Design: Prospective randomized study. Setting: Training and research hospital. Patients: 60 adult, ASA physical status 1 and 2 patients, ages 20-60 years, scheduled for elective arthroscopic knee surgery for meniscal and chondral lesions. Interventions: The initial hemodynamic parameters were recorded and blood samples were collected at baseline (T1); then spinal anesthesia was performed. In Group I (n=30), a combination of 0.5 mg/kg/hr of ketamine and 2 mg/kg/hr of propofol was administered; Group II (n=30) received an equivalent volume of saline as an infusion. A pneumatic tourniquet was applied. Measurements: Malondialdehyde (MDA), superoxide dismutase (SOD), and catalase levels were measured one minute before tournique deflation in the ischemic period (T2), then 5 (T3) and 30 (T4) minutes following tourniquet deflation in the reperfusion period. Main Results: No differences were noted between groups in hemodynamic data (P N 0.05) or SOD levels (P N 0.05). In Group I, MDA levels at T2 were lower than in Group II (P b 0.05). In Group I, catalase levels were lower at T2 and T4 than they were in Group II (P b 0.05). Conclusion: Small-dose ketamine-propofol combination may be useful in reducing tourniquet-induced ischemia-reperfusion injury in arthroscopic knee surgery.