Perioperative high-dose oxygen therapy in vascular surgery.
BACKGROUND
Patients undergoing infrainguinal bypass surgery have reduced baseline tissue oxygen tension and high rates of wound infections. The hypoxaemia worsens during surgery, potentially reducing the ability to combat bacterial lodgement. We investigated whether high-dose perioperative oxygen administration to patients undergoing infrainguinal arterial surgery results in increased tissue oxygenation.


METHODS
Ten consecutive patients undergoing infrainguinal arterial surgery had transcutaneous partial pressure of oxygen (TcpO(2)) measured preoperatively, intraoperatively after arterial clamps applied, postoperatively and at discharge. Measurements were taken with inspired oxygen concentration (F(i)O(2)) of 30% then 80%. Arterial blood gases were measured at the same times.


RESULTS
Tissue oxygenation showed no difference intraoperatively while arterial clamps were in place, but significantly higher tissue oxygenation was seen with use of high-dose oxygen (F(i)O(2) 80%) postoperatively (P<0.05). Carbon dioxide levels in tissue increased while arterial clamps were in place (P<0.01) and pH fell intraoperatively and following reperfusion (P<0.05).


CONCLUSIONS
The administration of high-dose oxygen to vascular surgical patients undergoing lower-limb arterial surgery results in increased tissue oxygen concentrations when perfusion is not reduced by the presence of arterial clamps. These results suggest the administration of high-dose oxygen intraoperatively may be beneficial in reducing wound infections, but further research is required.
Puckridge
Phillip J
PJ
Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand. phillip.puckridge@rgh.sa.gov.au
Saleem
Hafees A
HA
Vasudevan
Thodur M
TM
Holdaway
Christopher M
CM
Ferrar
David W
DW
D000368:Aged; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage* / Q000032:analysis / Q000097:blood; D010313:Partial Pressure; D019990:Perioperative Care; D013530:Surgical Wound Infection / Q000517:prevention & control*; D014656:Vascular Surgical Procedures
D010100:Oxygen