title: Effect of ischemic and pharmacological preconditioning of lower limb muscle tissue on tissue oxygenation measured by near-infrared spectroscopy--a pilot study.
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.
  
  
  BACKGROUND
  The trial has been registrated at http://www.ClinicalTrial.gov,
  
  
  BACKGROUND
  NCT02038062 at 14 January 2014.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel D-24105, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Fudickar
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel D-24105, Germany.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kunath
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel D-24105, Germany.
authors.forename: Dana
authors.initials: D
authors.lastname: Voß
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Siggelkow
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel D-24105, Germany.
authors.forename: Erol
authors.initials: E
authors.lastname: Cavus
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel D-24105, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel D-24105, Germany.
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
mesh_terms: D000368:Aged; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D019194:Ischemic Preconditioning / Q000379:methods*; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000098:blood supply* / Q000378:metabolism / Q000601:surgery*; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology*; D010865:Pilot Projects; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000187:drug effects; D015424:Reperfusion; D000077149:Sevoflurane; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
keywords: Arterial occlusive disease; Ischemic preconditioning; Sevoflurane; Surgical revascularization