Pulmonary Gas Exchange Impairment Following Tourniquet Deflation: A Prospective, Single-Blind Clinical Trial

Abstract

The tourniquet has been considered as a recognized cause of limb ischemia/reperfusion injury in orthopedic surgery resulting in a transient neutrophil, monocyte activation, and enhanced neutrophil transendothelial migration with potential remote tissue injury. This study investigated the effect of unilateral tourniquet application within a safe time limit on pulmonary function and the roles of lipid peroxidation and systemic inflammatory response. Thirty patients undergoing unilateral lower extremity surgery with or without tourniquet were equally divided into a control group with no tourniquet (Group C) and a tourniquet (Group T). Arterial partial pressure of oxygen (P(a)O(2)), arterial-alveolar oxygen tension ratio (a/A ratio), alveolar-arterial oxygen difference (A-aDO(2)) and respiratory index, plasma malondialdehyde, serum interleukin (IL) -6 and IL-8 levels were measured immediately before and 1 hour after tourniquet inflation/operation beginning, 0.5, 2, 6, and 24 hours after tourniquet deflation/operation ending. The results represented no significant changes in Group C with regard to either blood gas variables or levels of circulating mediators, while blood gas variable changes of greater A-aDO(2) and respiratory index and lower PaO2 and a/A ratio were shown at 6 hours following tourniquet deflation. The levels of malondialdehyde, IL-6, and IL-8 were increased over baseline values from 2 to 24 hours following tourniquet deflation in Group T. We concluded that tourniquet application within a safe time limit may cause pulmonary gas exchange impairment several hours after tourniquet deflation, where lipid peroxidation and systemic inflammatory response may be involved.

The Effect of Transcutaneous Electrical Acupoint Stimulation on Inflammatory Response in Patients Undergoing Limb Ischemia-Reperfusion

“…The a/A ratio, A-aO 2 , and respiratory index can be used to assess pulmonary gas exchange. We found that the a/A ratio, A-aO 2 , and respiratory index were significantly decreased at 6 h after tourniquet release, implying that gas exchange in the lungs was impaired, similar to our findings from a previous study [ 10 ]. In addition, we found that these indices were improved by TEAS.…”

“…This condition may be much more important in orthopedic procedures in which tourniquet-related ischemia-reperfusion damage develops and the lung gets injured [ 9 ]. Our previous research showed that tourniquet-induced lung injury was correlated with impaired gas exchange and that inflammation factors such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor- α (TNF- α ) are important mediators of this effect [ 10 ]. This suggests that reducing the inflammatory response should have a positive effect on postoperative recovery.…”

Tourniquet in Surgery of the Limbs: A Review of History, Types and Complications

“…Tourniquets may increase blood pressure, probably because of autonomous nervous system changes ( 74 ) and, especially, in children, it may induce hyperthermia. Pulmonary gas exchange disorder may occur a few hours after tourniquet deflation and in the safe time limit of tourniquet time ( 75 ). After deflation pulse and end tidal Co 2 increases to reach a peak after 5 minutes and after 15 minutes returns to the normal range.…”

Tourniquet Use During Knee Replacement Surgery May Contribute to Muscle Atrophy in Older Adults

“…Measures of atrophy, strength and functional mobility were not performed (38). The remainder of studies cited were conducted with younger adults during and after ACL reconstruction (6), with meniscectomy patients (39), with young patients having ORIF (19), and with subjects requiring surgery for femoral shaft fractures (control group) and tibial and ankle fractures (tourniquet group) (24) that reported changes in measures of pulmonary function.…”