Prevalence of cyclic changes in limb volume (volumotion) of male patients with knee injury and the effects of ischemia/reperfusion due to tourniquet.
During surgery of limbs tourniquet up to a maximum of 2 h is frequently applied which may cause ischemia/reperfusion injury (IRI). During this condition the presence of vasomotion may have consequences for the perfusion and nutritive state of the tissues. We used a noninvasive plethysmographic method to investigate periodic changes in limb circumference (volumotion) in healthy male patients (n = 24) undergoing surgery for knee injury. To facilitate surgery a tourniquet was applied to the thigh, which caused an IRI of the leg. Results are given as mean of all values +/- SEM. Immediately after tourniquet release (duration 57.75 +/- 5.19 min) blood lactate levels in the femoral vein increased significantly from 1.40 +/- 0.08 to 2.59 +/- 0.20 mmol/l (p < 0.001) and pH fell from 7.39 +/- 0.01 to 7.32 +/- 0.01 (p < 0.001). Preoperatively 10 out of 24 patients (42%) showed signs of volumotion on the injured leg with a periodicity ranging from 0.8 to 6.9 cycles/min, whereas none showed volumotion in the control leg (p < 0.001). In the second measurement, taken after surgery and reperfusion while peripheral sympathetic nerves were blocked, 7 out of 18 patients (39%) showed volumotion on the injured leg and 0 on the control leg (p < 0.004). 6 h after IRI, volumotion was observed in 11 out of 17 patients (65%) on the injured leg and in 1 patient (6%) on the control leg (p < 0.001). The mean volume change in the patients with volumotion on the injured leg was 0.057 +/- 0.007 ml/100 ml tissues.(ABSTRACT TRUNCATED AT 250 WORDS)
Christ
F
F
Department of Anaesthesiology, Ludwig Maximilian University Munich, Germany.
Moser
C M
CM
Niklas
M
M
Gartside
I B
IB
Gamble
J
J
Refior
H J
HJ
Peter
K
K
Messmer
K
K
D000328:Adult; D000775:Anesthesia, Spinal; D001182:Arthroscopy / Q000009:adverse effects; D001340:Autonomic Nerve Block; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D010507:Periodicity; D011183:Postoperative Complications; D015427:Reperfusion Injury / Q000209:etiology / Q000473:pathology*; D014111:Tourniquets / Q000009:adverse effects*