Stoffwechselveränderungen und Restitution nach temporärer Tourniquet-Ischämie beim Menschen

Biochemical and hemodynamic changes during and after operation in a bloodless field have been investigated in 13 patients. The patients were athletes between the ages of 21 and 38 years who were healthy except for an inveterate ligament injury of the knee joint. Capillary blood flow in the tibialis anterior muscle was measured by the radioactive-Xenon-clearance technique. Fine plastic catheters for blood sampling were inserted into both femoral veins and into one radial artery. A significant increase in blood flow occurred immediately after release of the occlusion. After release of the tourniquet, there was a marked decrease in pH both in the venous blood draining the operated leg and in the arterial blood. 40 min after release of the tourniquet, there was still a significant decrease in base excess. An increase of venous pO₂ in the blood draining the operated leg was observed after re-establishment of blood flow. The estimated oxygen consumption was increased in the operated leg the first 10 min after tourniquet release.

Section: Discussionsupporting

confidence: 83%

Section: /L Ew Is/l üJedahl/lôfstrômmentioning

confidence: 99%

Early Biochemical and Hemodynamic Changes after Operation in a Bloodless Field

Larsson¹,

Lewis²,

Liljedahl³

et al. 1977

“…The cellular metabolic deterioration during the course of the tourni quet ischemia was in agreement with previous clinical [8,9,14], as well as experimental data [1,19,20]. Anaerobic glycolysis and phosphagen depletion has been shown to start in skeletal muscle approximately 10-15 min after circulatory occlusion, since the remaining local oxygen stores are depleted after such a time period [11].…”

Section: Discussionsupporting

confidence: 77%

“…A 2-hour period has, however, on empirical bases been considered as 'safe' [2,6,18]. Recent clinical as well as experi mental studies on skeletal muscle have also verified that cellular metabol ic restitution is rapid after such ischemic durations [7,8,14,20,21].…”

Section: Introductionmentioning

confidence: 99%

Cellular Restitution after 3 h of Complete Tourniquet Ischemia

Enger¹,

Jennische²,

Medegård³

et al. 1978

The refinement of techniques for extremity surgery makes it urgent to get more information at cell level of the effects of tourniquet times exceeding the usually accepted 90–120 min. Therefore, in the present experiments, the cellular metabolic and functional restitution of canine skeletal muscle after 3 h of complete tourniquet ischemia was studied. During the ischemia and after recirculation, repeated skeletal muscle samples were taken for ATP, CP and lactate analyses. At the same time periods, blood from a regional vein and vena cava was drawn for pH, pyruvate and lactate analyses. Cellular function was evaluated from repeated measurements of transmembrane potentials. The tourniquet ischemia resulted in a rapid decrease of CP to 40% of the initial level within 1 h and a continuous decrease of ATP. The lactate levels increased continuously. The transmembrane potentials decreased from an initial level of -90 to –54 mV. The release of the tourniquet resulted in a hyperemic reaction and a rapid regain of tissue CP and ATP levels within 5 min of recirculation. There was a continuous washout of lactate up to about 1 h after the release and the transmembrane potentials were normalized after about the same time period. The latter parameters indicate that areas of no-reflow persisted for up to 1 h after restored circulation. The results indicate that after a 3-hour tourniquet ischema, the cellular energy metabolism as well as the membrane function are completely normalized after about 1 h of recirculation.

“…With regard to longer durations of ischemia in man, i.e. up to several hours, data are available on temperature changes [14] and changes in muscle metabolites [6] but data on the local hemodynamic ef fects in skeletal muscle are much less common.…”

Section: Discussionmentioning

confidence: 99%

The Local Hemodynamic Effects of Operation in a Bloodless Field

Larsson

Lewis

1978

Skeletal muscle blood flow and transport function were investigated in 25 patients operated on for a knee injury in a bloodless field. With a double-isotope-clearance technique, measurements were carried out in the operated leg immediately after re-establishment of blood flow, and 1–2 days postoperatively in both the operated and the non-operated leg. A significant increase in blood flow and transport function was registered immediately after release of the tourniquet. The initial maximal hyperemic flow and transport responses were inversely related to the duration of the occlusion. The peak of the blood flow response was more marked and somewhat earlier in the patients with a short duration of occlusion (<60 min) than in those with longer occlusions. 9 of 16 operated legs showed a maximal transport function 1–2 days postoperatively. Peripheral vascular resistance decreased after re-establishment of blood flow. The blood flow in the non-operated leg showed no changes after release of the tourniquet in the operated leg.