Clinical biochemical tissue monitoring during ischaemia and reperfusion in major vascular surgery.
BACKGROUND
Major vascular surgery with aortic cross-clamping is associated with temporary ischaemia of the lower limb due to lack of tissue blood flow. The present study was designed to determine if the short-term changes in cellular metabolism occurring during this situation can be detected by subcutaneous microdialysis. It was also hoped to ascertain if this new technique is useful in the continuous bedside monitoring of metabolism during aortic surgery.


METHODS
In a controlled clinical study 20 patients undergoing elective aortic surgery were monitored using microdialysis probes that were inserted in the subcutaneous tissue of the left lower limb and a non-ischaemic region (shoulder). Interstitial fluid was obtained and the concentrations of glucose and lactate during lower limb ischaemia and during reperfusion were measured and compared with concentrations observed in fluid obtained from the non-ischaemic control tissue.


RESULTS
Circulatory occlusion caused an immediate and significant decrease in the glucose/lactate ratio from 3.1+/-1.3 to 0.48+/-0.5 (P<0.05) that returned to preocclusion values within 2 h of commencing reperfusion.


CONCLUSIONS
We suggest that microdialysis may be used both to assess acute changes in tissue metabolism during ischaemic periods and also to act as an additional tool for the detection of peri-operative acute variations in limb blood flow.
Klaus
S
S
Department of Anaesthesiology, Medical University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany. stephan.klaus@epost.de
Staubach
K H
KH
Eichler
W
W
Gliemroth
J
J
Heringlake
M
M
Schmucker
P
P
Bahlmann
L
L
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D005121:Extremities / Q000098:blood supply*; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007511:Ischemia / Q000378:metabolism / Q000517:prevention & control*; D019344:Lactic Acid / Q000378:metabolism; D017551:Microdialysis; D008875:Middle Aged; D019990:Perioperative Care; D015424:Reperfusion; D040521:Subcutaneous Tissue / Q000378:metabolism; D014656:Vascular Surgical Procedures
D001786:Blood Glucose; D019344:Lactic Acid; D005947:Glucose