Effect of ischemic and pharmacological preconditioning of lower limb muscle tissue on tissue oxygenation measured by near-infrared spectroscopy – a pilot study

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.

A systematic review and meta-analysis of remote ischemic preconditioning for vascular surgery

“…A single article was identified through review of references. Of the 23 articles, 4 were removed because of being reviews, 1,4,13,14 2 used anesthetic agents only, 15,16 2 were protocols, 17,18 and 2 were not relevant, 19,20 leaving 13 articles for inclusion [21][22][23][24][25][26][27][28][29][30][31][32][33] (Fig 1).…”

“…21,24,28 There was also no significant difference in overall length of stay in any study. 21,22,24,28,30,32,33 Heterogeneity. Supplementary Table III (online only) shows heterogeneity statistics for the four outcomes considered.…”

Limb Remote Ischemic Preconditioning Applied During Sevoflurane Anesthesia Does Not Protect the Lungs in Patients Undergoing Adult Heart Valve Surgery

“…Animal experiments demonstrated that ischemic preconditioning showed no protective effect in I/R injury when pharmacologic preconditioning (isoflurane or sevoflurane) was administered concomitantly [Vianna 2009;Kuzume 2004]. However, if administered sequentially, it provided synergistic effects [Toller 1999;Fudickar 2014]. Lucchinetti et al [Lucchinetti 2012] reported that RIPC combined with isoflurane administered concomitantly provided no additional benefit to the myocardium and revealed a lack of synergy or evidence of antagonism in cardioprotection in both strategies.…”

The Protective Properties of Sevoflurane at Ischemia-Reperfusion Injury of Transplanted Cadaveric Kidney

“…Это подтверждается не только более низким уровнем специфических маркеров повреждения миокарда, но и снижением в периоперационном периоде частоты осложнений. Ишемическое прекондиционирование севофлюраном оказывает влияние и на оксигенацию тканей у больных с окклюзионными поражениями артерий нижних конечностей [15][16][17][18].…”