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

Axel Fudickar, Sarah Kunath, Dana Voß, Markus Siggelkow, Erol Cavus, Markus Steinfath, Berthold Bein, Axel Fudickar, Sarah Kunath, Dana Voß, Markus Siggelkow, Erol Cavus, Markus Steinfath, Berthold Bein

Abstract

Background: Ischemic 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.

Methods: In 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).

Results: Repetitive 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.

Conclusions: Ischemic 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 registration: The trial has been registrated at http://www.ClinicalTrial.gov,

Trial number: NCT02038062 at 14 January 2014.

Keywords: Arterial occlusive disease; Ischemic preconditioning; Sevoflurane; Surgical revascularization.

Figures

Figure 1
Figure 1
rSO2 in the anterior tibial muscle during sevoflurane preconditioning and in a time-matched interval. rSO2 in the anterior tibial muscle of patients during sevoflurane preconditioning (IPC + Sevoflurane, n = 20) and rSO2 of patients without sevoflurane preconditioning (IPC, n = 20) during a corresponding time-matched interval between induction of anesthesia and ischemic preconditioning. There was no significant difference between the groups. rSO2 has been normalized to baseline prior to induction of anesthesia to facilitate group comparison.
Figure 2
Figure 2
rSO2 in the anterior tibial muscle during ischemic preconditioning. rSO2 in the anterior tibial muscle during ischemic preconditioning with (IPC + Sevoflurane, n = 20) and without (IPC, n = 20) sevoflurane preconditioning before ischemic preconditioning. There was a significant effect of the factor “time” (p < 0.0001) and the combination of the factors “time” and “sevoflurane” (p = < 0.0001) on rSO2. rSO2 was normalized to baseline prior to induction of anesthesia to facilitate group comparison.
Figure 3
Figure 3
rSO2 in the anterior tibial muscle during clamping of the femoral artery for surgery. rSO2 in the anterior tibial muscle during clamping of the femoral artery for surgery with (IPC + sevoflurane) and without (IPC) sevoflurane preconditioning before ischemic preconditioning (IPC). There was a significant effect of the factor “time” on rSO2 (p < 0.0001), but no significant difference between the groups. rSO2 was normalized to baseline prior to induction of anesthesia to facilitate group comparison.
Figure 4
Figure 4
rSO2 in the anterior tibial muscle after declamping of the femoral artery. rSO2 in the anterior tibial muscle after declamping of the femoral artery in patients with sevoflurane preconditioning (IPC + sevoflurane, n = 20) and without sevoflurane preconditioning (IPC, n = 20) before ischemic preconditioning (IPC). rSO2 was normalized to baseline prior to induction of anesthesia to facilitate group comparison.

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