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Lichte P, Bläsius FM, Ganse B, Gueorguiev B, Pastor T, Nebelung S, Migliorini F, Klos K, Modabber A, Scaglioni MF, Schopper C, Hildebrand F, Knobe M. Intraoperative pneumatic tourniquet application reduces soft-tissue microcirculation, but without affecting wound healing in calcaneal fractures. Eur J Med Res 2024; 29:462. [PMID: 39289760 PMCID: PMC11406720 DOI: 10.1186/s40001-024-01996-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 07/22/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND Wound healing complications are a major challenge following the extended lateral approach in calcaneal fractures. Soft-tissue microcirculation plays an important role via the delivery of oxygen, nutrients, and the regulation of a local milieu. The aim of this clinical study was to examine the effect of intraoperative pneumatic tourniquet application on skin and subcutaneous microcirculation, and its impact on wound healing progression. METHODS Patients with calcaneal fractures were randomly assigned to two groups defined by a surgery conducted either with use or without use of a tourniquet. Blood flow (BF [AU]), tissue oxygen saturation (SO2[%]) and the relative amount of haemoglobin (rHb[AU]) were intraoperatively measured at two depths (2 and 8 mm) non-invasively by spectrophotometry (Micro-Lightguide O2C®, LEA Medizintechnik, Giessen, Germany). Time points were before and after inflation of the pneumatic tourniquet and also at the end of surgery before deflation. A linear mixed model (LMM) was fitted for statistical analysis. RESULTS Thirty-four patients (3 women and 31 men) with 37 calcaneal fractures were included. In 22 of them, the surgery was conducted with a tourniquet and in the other 15 without its use. A significant decrease of microcirculation, characterized by decreases in blood flow (p = 0.011) and tissue oxygenation (p = 0.023) was measured in 8 mm depth after inflating the tourniquet. However, these changes did not influence the time of postoperative wound healing. CONCLUSION The use of a pneumatic tourniquet reduces deep microcirculation without affecting postoperative wound healing. Trial registration The study was registered in www. CLINICALTRIALS gov (NCT01264146).
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Affiliation(s)
- Philipp Lichte
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany.
| | - Felix M Bläsius
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Bergita Ganse
- Werner Siemens Foundation Endowed Chair of Innovative Implant Development, Saarland University, Homburg, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Homburg, Germany
| | | | - Torsten Pastor
- Department of Orthopaedic and Trauma Surgery, Cantonal Hospital Lucerne, 6000, Lucerne, Switzerland
| | - Sven Nebelung
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, 52074, Aachen, Germany
| | - Filippo Migliorini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Kajetan Klos
- Gelenkzentrum Rhein-Main, Hochheim, Germany
- Department of Trauma, Hand and Reconstructive Surgery, Jena University Hospital, Friedrich Schiller University Jena, 07747, Jena, Germany
| | - Ali Modabber
- Department of Oral and Maxillofacial Surgery, University Hospital of Aachen, Aachen, Germany
| | - Mario F Scaglioni
- Department of Hand- and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Clemens Schopper
- Department for Orthopedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Linz, Austria
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Matthias Knobe
- Medical Faculty, University of Zurich, 8091, Zurich, Switzerland.
- Medical Faculty, RWTH Aachen University Hospital, 52074, Aachen, Germany.
- Department of Orthopaedic Trauma, Westmuensterland Hospital, 48683, Ahaus, Germany.
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Martinez-Canton M, Galvan-Alvarez V, Gallego-Selles A, Gelabert-Rebato M, Garcia-Gonzalez E, Gonzalez-Henriquez JJ, Martin-Rincon M, Calbet JAL. Activation of macroautophagy and chaperone-mediated autophagy in human skeletal muscle by high-intensity exercise in normoxia and hypoxia and after recovery with or without post-exercise ischemia. Free Radic Biol Med 2024; 222:607-624. [PMID: 39009244 DOI: 10.1016/j.freeradbiomed.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/25/2024] [Accepted: 07/11/2024] [Indexed: 07/17/2024]
Abstract
Autophagy is essential for the adaptive response to exercise and physiological skeletal muscle functionality. However, the mechanisms leading to the activation of macroautophagy and chaperone-mediated autophagy in human skeletal muscle in response to high-intensity exercise remain elusive. Our findings demonstrate that macroautophagy and chaperone-mediated autophagy are stimulated by high-intensity exercise in normoxia (PIO2: 143 mmHg) and severe acute hypoxia (PIO2: 73 mmHg) in healthy humans. High-intensity exercise induces macroautophagy initiation through AMPKα phosphorylation, which phosphorylates and activates ULK1. ULK1 phosphorylates BECN1 at Ser15, eliciting the dissociation of BECN1-BCL2 crucial for phagophore formation. Besides, high-intensity exercise elevates the LC3B-II:LC3B-I ratio, reduces total SQSTM1/p62 levels, and induces p-Ser349 SQSTM1/p62 phosphorylation, suggesting heightened autophagosome degradation. PHAF1/MYTHO, a novel macroautophagy biomarker, is highly upregulated in response to high-intensity exercise. The latter is accompanied by elevated LAMP2A expression, indicating chaperone-mediated autophagy activation regardless of post-exercise HSPA8/HSC70 downregulation. Despite increased glycolytic metabolism, severe acute hypoxia does not exacerbate the autophagy signaling response. Signaling changes revert within 1 min of recovery with free circulation, while the application of immediate post-exercise ischemia impedes recovery. Our study concludes that macroautophagy and chaperone-mediated autophagy pathways are strongly activated by high-intensity exercise, regardless of PO2, and that oxygenation is necessary to revert these signals to pre-exercise values. PHAF1/MYTHO emerges as a pivotal exercise-responsive autophagy marker positively associated with the LC3B-II:LC3B-I ratio.
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Affiliation(s)
- Miriam Martinez-Canton
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Victor Galvan-Alvarez
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Angel Gallego-Selles
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Miriam Gelabert-Rebato
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Eduardo Garcia-Gonzalez
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Juan Jose Gonzalez-Henriquez
- Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain; Department of Mathematics, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain
| | - Marcos Martin-Rincon
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain
| | - Jose A L Calbet
- Department of Physical Education, University of Las Palmas de Gran Canaria, Campus Universitario de Tafira s/n, Las Palmas de Gran Canaria, 35017, Spain; Research Institute of Biomedical and Health Sciences (IUIBS), University of Las Palmas de Gran Canaria, Canary Islands, Spain; Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway.
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van der Kraats AM, Winkes M, Janzing HM, Eijkelenboom RP, de Koning MT. Review of Reliable and Valid Noninvasive Tools for the Diagnosis of Chronic Exertional Compartment Syndrome. Orthop J Sports Med 2023; 11:23259671221145151. [PMID: 36655016 PMCID: PMC9841863 DOI: 10.1177/23259671221145151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 01/15/2023] Open
Abstract
Background Currently, invasive dynamic intracompartmental pressure (ICP) measurements are considered the gold standard for diagnosis of chronic exertional compartment syndrome (CECS). During recent years, different noninvasive imaging modalities have been presented as a possible replacement for ICP measurement. Purpose To provide an overview of the current state of evidence and possibilities regarding noninvasive diagnostic methods for CECS. Study Design Scoping review; Level of evidence, 4. Methods The PubMed (MEDLINE) and Embase databases were searched using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Full-text articles were included if they reported on noninvasive diagnostic methods for CECS, included ≥5 patients with CECS, and were published between 1994 and 2022. Articles not written in English were excluded. Systematic reviews, letters to the editor, and case reports were not eligible for inclusion. Out of 961 articles identified in the initial search, 25 studies (N = 1257 participants) were included. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) tool for comparative studies and the QUADAS-2 tool for noncomparative studies. Narrative synthesis was used to present results. Results The level of evidence for the 25 studies ranged from 2 to 4. Four studies were classified as having a low risk of bias, 21 studies were classified as being at risk of bias. The following noninvasive diagnostic tools for CECS were reported: magnetic resonance imaging/diffusion tensor imaging (n = 8), near-infrared spectroscopy (n = 6), electromyography (n = 4), single-photon emission computed tomography (n = 5), ultrasound (n = 2), myotonometry (n=1) and predictive clinical model (n = 1). There was insufficient evidence in the literature to support the use of any of these noninvasive diagnostic tools as a gold standard for CECS. Conclusion Despite the need to replace the controversial use of ICP for the diagnosis of CECS, our review indicated a lack of validity on all discussed noninvasive diagnostic tools as a replacement.
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Affiliation(s)
- Annick M. van der Kraats
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands.,Annick M. van der Kraats, BSc, Department of Surgery, VieCuri Medical Center, Tegelseweg 210, 5912 BL, Venlo, the Netherlands ()
| | - Michiel Winkes
- Department of Surgery, VieCuri Medical Center, Venlo, the Netherlands
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Philipopoulos GP, Sharareh B, Ganesan G, Tromberg BJ, O’Sullivan TD, Schwarzkopf R. Characterizing tourniquet induced hemodynamics during total knee arthroplasty using diffuse optical spectroscopy. J Orthop Res 2023; 41:104-114. [PMID: 35289956 PMCID: PMC9475493 DOI: 10.1002/jor.25327] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/03/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
Tourniquet use creates a reduced blood surgical field during total knee arthroplasty (TKA), however, prolonged ischemia may cause postoperative tourniquet complications. To understand the effects of tourniquet-induced ischemia, we performed a prospective observational study using quantitative broadband diffuse optical spectroscopy (DOS) to measure tissue hemodynamics and water and lipid concentrations before, during, and after tourniquet placement in subjects undergoing TKA. Data was collected for 6 months and, of the total subjects analyzed (n = 24), 22 were primary TKAs and 2 were revision TKA cases. We specifically investigated tourniquet-induced hemodynamics based upon subject-specific tissue composition and observed a significant relationship between the linear rate of deoxygenation after tourniquet inflation and water/lipid ratio (W/L, p < 0.0001) and baseline somatic tissue oxygen saturation, StO2 (p = 0.05). Subjects with a low W/L ratio exhibited a lower tissue metabolic rate of oxygen consumption, (tMRO2 ) (p = 0.008). Changes in deoxyhemoglobin [HbR] (p = 0.009) and lipid fraction (p = 0.001) were significantly different between high and low W/L subject groups during deoxygenation. No significant differences were observed for hemodynamics during reperfusion and total tourniquet time was neither significantly related to the hemodynamic hyperemic response (p = 0.73) nor the time to max StO2 after tourniquet release (p = 0.57). In conclusion, we demonstrate that DOS is capable of real-time monitoring of tissue hemodynamics distal to the tourniquet during TKA, and that tissue composition should be considered. DOS may help surgeons stratify hemodynamics based upon tissue composition and eventually aid the preoperative risk assessment of vascular occlusions from tourniquet use during TKA.
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Affiliation(s)
- George P. Philipopoulos
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, 1002 Health Sciences Road, Irvine, CA 92617, USA
| | - Behnam Sharareh
- University of Washington, Department of Orthopaedics and Sport Medicine, Seattle, WA, USA
| | - Goutham Ganesan
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, 1002 Health Sciences Road, Irvine, CA 92617, USA
- University of California Irvine, Institute for Clinical and Translation Science, 843 Hewitt Hall, Irvine, USA, 92617
| | - Bruce J. Tromberg
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Laser Microbeam and Medical Program, 1002 Health Sciences Road, Irvine, CA 92617, USA
| | - Thomas D. O’Sullivan
- University of Notre Dame, Department of Electrical Engineering, 275 Fitzpatrick Hall, Notre Dame, IN 46556 USA
| | - Ran Schwarzkopf
- NYU Langone Orthopaedic Hospital, Hospital for Joint Diseases, 301 East 17 Street, New York, NY 10003 USA
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Hao N, Cui M, Shi Y, Liu Z, Li X, Chen Y, Zhao G. Measurement of tissue oxygen saturation during arthroscopic surgery of knee with a tourniquet. J Orthop Surg Res 2022; 17:532. [PMID: 36494737 PMCID: PMC9733324 DOI: 10.1186/s13018-022-03431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tourniquets provide better tissue visibility during arthroscopic surgery. However, multiple postoperative adverse events associated with ischemia may be caused by excessive inflation pressure and duration. We aimed to evaluate the degree of tourniquet-induced ischemia using a noninvasive continuous real-time monitoring method and the relationship between changes in tissue oxygen saturation (StO2) and blood biochemical markers of ischemic injuries in patients undergoing arthroscopic knee surgery. METHODS This was a prospective observational study using near-infrared spectroscopy (NIRS). Data were collected from 29 consecutive patients who underwent arthroscopic procedures. Twenty-five patients underwent anterior cruciate ligament reconstruction, and four underwent meniscal repair. We investigated tourniquet-induced changes in StO2, monitored using NIRS, and blood biochemical markers of ischemic injuries. RESULTS A significant decrease in the mean StO2 from the baseline was observed during tourniquet inflation in the operative legs. The average decrease in the mean StO2 was 58%. A comparison of mean StO2 between the nonoperative and operative legs before tourniquet deflation showed that mean values of StO2 in the operative legs were significantly lower than those in the nonoperative legs. No significant clinical relationships were observed between changes in StO2 and blood biochemical markers of ischemic injuries (creatine kinase) (p = 0.04, r = 0.38) or tourniquet duration (p = 0.05, r = 0.366). CONCLUSIONS Our results demonstrated that StO2 could be used to evaluate tissue perfusion in real time but did not support the hypothesis that StO2 is a useful method for predicting the degree of tourniquet-induced injury during arthroscopic knee surgery.
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Affiliation(s)
- Ning Hao
- grid.411866.c0000 0000 8848 7685The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 Guangdong China ,grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Mengxue Cui
- grid.411866.c0000 0000 8848 7685Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Yongyong Shi
- grid.411866.c0000 0000 8848 7685The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 Guangdong China
| | - Zitao Liu
- grid.411866.c0000 0000 8848 7685Department of Orthopaedics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Xiangyu Li
- grid.411866.c0000 0000 8848 7685The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 Guangdong China
| | - Yansheng Chen
- grid.411866.c0000 0000 8848 7685The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 Guangdong China
| | - Gaofeng Zhao
- grid.411866.c0000 0000 8848 7685The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 Guangdong China
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Deng P, Qiu S, Liao F, Jiang Y, Zheng C, Zhu Q. Contusion concomitant with ischemia injury aggravates skeletal muscle necrosis and hinders muscle functional recovery. Exp Biol Med (Maywood) 2022; 247:1577-1590. [PMID: 35775612 PMCID: PMC9554171 DOI: 10.1177/15353702221102376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Contusion concomitant with ischemia injury to skeletal muscles is common in civilian and battlefield trauma. Despite their clinical importance, few experimental studies on these injuries are reported. The present study established a rat skeletal muscle contusion concomitant with ischemia injury model to identify skeletal muscle alterations compared with contusion injury or ischemia injury. Macroscopic and microscopic morphological evaluation showed that contusion concomitant with ischemia injury aggravated muscle edema and hematoxylin-eosin (HE) injury score at 24 h postinjury. Serum creatine kinase (CK) and lactate dehydrogenase (LDH) levels, together with gastrocnemius muscle (GM) tumor necrosis factor-alpha (TNF-α) content elevated at 24 h postinjury too. During the 28-day follow-up, electrophysiological and contractile impairment was more severe in the contusion concomitant with ischemia injury group. In addition, contusion concomitant with ischemia injury decreased the percentage of larger (600-3000 μm2) fibers and increased the fibrotic area and collagen I proportion in the GM. Smaller proportions of Pax7+ and MyoD+ satellite cells (SCs) were observed in the contusion concomitant with ischemia injury group at 7 days postinjury. In conclusion, contusion concomitant with ischemia injury to skeletal muscle not only aggravates early muscle fiber necrosis but also hinders muscle functional recovery by impairing SC differentiation and exacerbating fibrosis during skeletal muscle repair.
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Affiliation(s)
- Peijun Deng
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Guangzhou 510080, China,Guangdong Provincial Peripheral Nerve Tissue Engineering and Technology Research Center, Guangzhou 510080, China,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou 510080, China
| | - Shuai Qiu
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Guangzhou 510080, China,Guangdong Provincial Peripheral Nerve Tissue Engineering and Technology Research Center, Guangzhou 510080, China,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou 510080, China
| | - Fawei Liao
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Guangzhou 510080, China,Guangdong Provincial Peripheral Nerve Tissue Engineering and Technology Research Center, Guangzhou 510080, China,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou 510080, China
| | - Yifei Jiang
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Guangzhou 510080, China,Guangdong Provincial Peripheral Nerve Tissue Engineering and Technology Research Center, Guangzhou 510080, China,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou 510080, China
| | - Canbin Zheng
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Guangzhou 510080, China,Guangdong Provincial Peripheral Nerve Tissue Engineering and Technology Research Center, Guangzhou 510080, China,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou 510080, China
| | - Qingtang Zhu
- Department of Microsurgery, Orthopedic Trauma and Hand Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China,Guangdong Province Engineering Laboratory for Soft Tissue Biofabrication, Guangzhou 510080, China,Guangdong Provincial Peripheral Nerve Tissue Engineering and Technology Research Center, Guangzhou 510080, China,Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou 510080, China,Qingtang Zhu.
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Jouybar R, Khademi S, Razmjooie S, Bagheri N. Effect of Preoperative Administration of Oral Melatonin on Pneumatic Tourniquet-Induced Ischemia-Reperfusion Injury in Orthopedic Surgery of Lower Extremities: A Randomized Clinical Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:123-130. [PMID: 35291433 PMCID: PMC8919302 DOI: 10.30476/ijms.2021.86960.1701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 01/26/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
Background Ischemic reperfusion injury (IRI) causes cellular damage and dysfunction. The present study aimed to evaluate the effect of melatonin on pneumatic tourniquet-induced IRI in orthopedic surgery of the lower extremities. Methods A randomized clinical trial was conducted at Chamran Hospital, Shiraz University of Medical Sciences (Shiraz, Iran), from September to November 2019. The target population was patients scheduled for elective orthopedic surgery of the lower extremities. A total of 67 patients were randomly divided into two groups, placebo (n=34) and melatonin (n=33). The groups received 10 mg melatonin or placebo the night before surgery and two hours before surgery. Primary outcome variables were the serum levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Hemodynamic parameters, sedation score, and drug side effects were also evaluated. Data were analyzed using SPSS version 21.0 software. P<0.05 was considered statistically significant. Results In the analysis phase, due to loss to follow-up (n=26), 41 patients divided into two groups of melatonin (n=20) and placebo (n=21) were evaluated. There was no significant difference in demographic data, duration of surgery (P=0.929), and tourniquet time (P=0.496) between the groups. The serum levels of SOD and MDA were not significantly different between the groups (P=0.866 and P=0.422, respectively), nor were the incidence of postoperative nausea (P=0.588) and patients' satisfaction (P=0.088). However, the postoperative sedation score and vomiting between the groups were significantly different (P<0.001). Conclusion Administration of 10 mg melatonin provided effective sedation, but had no significant effect on the serum levels of SOD and MDA, nor on pneumatic tourniquet-induced IRI in orthopedic surgery of the lower limbs. Trial registration number IRCT20141009019470N87.
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Affiliation(s)
- Reza Jouybar
- Shiraz Anesthesiology and Critical Research Center, Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Khademi
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sima Razmjooie
- Anesthesiology and Critical Care Research Center, Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
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Gitajn IL, Werth PM, Sprague S, Bzovsky S, Petrisor BA, Jeray KJ, O'Hara NN, Bhandari M, Slobogean G. Effect of Tourniquet Use During Surgical Treatment of Open Fractures. J Bone Joint Surg Am 2021; 103:860-868. [PMID: 33877068 DOI: 10.2106/jbjs.20.01458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We sought to evaluate whether tourniquet use, with the resultant ischemia and reperfusion, during surgical treatment of an open lower-extremity fracture was associated with an increased risk of complications. METHODS This is a retrospective cohort study of 1,351 patients who had an open lower-extremity fracture at or distal to the proximal aspect of the tibia and who participated in the FLOW (Fluid Lavage of Open Wounds) trial. The independent variable was intraoperative tourniquet use, and the primary outcome measures were adjudicated unplanned reoperation within 1 year of the injury and adjudicated nonoperative wound complications. RESULTS Unplanned reoperation and nonoperative wound complications were roughly even between the no-tourniquet (18.7% and 19.1%, respectively) and tourniquet groups (17.8% and 20.8%) (p = 0.78 and p = 0.52). Following matching, as determined by model interactions, tourniquet use was a significant predictor of unplanned reoperation in Gustilo Type-IIIA (odds ratio, 3.60; 95% confidence interval, 1.16 to 11.78) and IIIB fractures (odds ratio, 16.61; 95% confidence interval, 2.15 to 355.40). CONCLUSIONS The present study showed that tourniquet use did not influence the likelihood of complications following surgical treatment of an open lower-extremity fracture. However, in cases of severe open fractures, tourniquet use was associated with increased odds of unplanned reoperation; surgeons should be cautious with regard to tourniquet use in this setting. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Paul M Werth
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | | | | | | | - Nathan N O'Hara
- University of Maryland School of Medicine, Baltimore, Maryland
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Near-infrared spectroscopy as a quantitative spasticity assessment tool: A systematic review. J Neurol Sci 2020; 412:116729. [PMID: 32120130 DOI: 10.1016/j.jns.2020.116729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/05/2020] [Accepted: 02/09/2020] [Indexed: 11/24/2022]
Abstract
The purpose of this paper is to systematically review the literature on the use of near-infrared spectroscopy (NIRS) for assessing spasticity. MEDLINE, CINAHL, and EMBASE were searched for human and/or animal studies written in the English language published until November 2018. that used NIRS to examine the hemodynamics and/or metabolism of spastic musculature were included. Of the 35 articles identified, five met the inclusion criteria. Two reviewers independently extracted spasticity outcomes, NIRS instrumentation specifications, and NIRS hemodynamic and metabolic measures from each article. Risk of bias was assessed using the Downs & Black tool for non-randomized studies. Three different models of NIRS devices were used in the five studies. Four studies examined the effects of passive limb movements and one examined active hand movements on NIRS parameters in spastic and non-spastic muscle. Owing to the small number and diverse nature of the studies, statistical comparison was deemed inappropriate. Rather, descriptive comparisons were drawn and levels of evidence were assigned based on the modified Sackett Scale. There is level 4 evidence that NIRS can non-invasively detect and measure differences between spastic and non-spastic muscles in blood volume and oxidative capacity changes over time or in response to interventions, and may correlate with other, established measures of spasticity, such as the Modified Ashworth Scale (MAS) and electromyography (EMG). Future research studies should use a validated definition of spasticity for inclusion criteria, a control group, and standardized NIRS variables.
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Effects of Tourniquets in the Development of Pain States: a Novel Clinical Pilot Study and Review of Utilization of Tissue Oximetry to Measure Neural Ischemia. Curr Pain Headache Rep 2020; 24:25. [PMID: 32323058 DOI: 10.1007/s11916-020-00855-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Approximately 20% of patients undergoing surgery develop persistent lower extremity pain following total knee arthroplasty. Animal studies have confirmed that prolonged tourniquet time increases the risk of endoneural ischemia and can mediate or modulate the development of chronic pain. The use of Near InfraRed Spectroscopy (NIRS) adjacent to nerve tissue, previously described as ONG has been shown to detect early neural compromise and has demonstrated clinical utility in carpal tunnel diagnosis. RECENT FINDINGS In this pilot study, we recruited 10 healthy adult volunteers to undergo oxyneurography (ONG) and sensory nerve conduction testing (sNCT). We performed testing on the upper and lower extremities in each individual. The tourniquet was applied followed by measurements of sNCT and ONG as described. We observed a significant drop in the mean ONG index at 3 and 5 min following tourniquet inflation in upper and lower extremities. Similar to raw ONG values, there was significant variability in sNCT measurements, which in general increased from baseline with tourniquet inflation. In the upper extremity, there was a significant increase in sNCT with tourniquet inflation, while in the lower extremity, there was a trend towards significance. The use of ONG can be supported as a diagnostic tool to detect nerve ischemia and to potentially reduce the incidence of tourniquet-mediated or -modulated neural ischemia and reduce the development of chronic post-tourniquet pain.
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Lin L, Li G, Li J, Meng L. Tourniquet-induced tissue hypoxia characterized by near-infrared spectroscopy during ankle surgery: an observational study. BMC Anesthesiol 2019; 19:70. [PMID: 31077128 PMCID: PMC6511202 DOI: 10.1186/s12871-019-0740-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/18/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pneumatic tourniquet inflation during extremity surgery leads to profound and prolonged tissue ischemia. Its effect on tissue oxygenation is inadequately studied. METHODS Patients undergoing elective ankle surgery with tourniquet application participated in this observational cohort study. Somatic and cerebral tissue oxygen saturation (SstO2 and SctO2) were monitored using tissue near-infrared spectroscopy. Oxygenation was monitored distally (SstO2-distal) and proximally to the tourniquet, on the contralateral leg, and the forehead (a total of 4 tissue beds). Tissue oxygenation at different time points was compared. The magnitude, duration, and load (product of magnitude and duration) of tissue desaturation during tourniquet inflation were correlated with tissue resaturation and hypersaturation after tourniquet deflation. RESULTS Data of 26 patients were analyzed. The tourniquet inflation time was 120 ± 31 mins. Following a rapid desaturation from 77 ± 8% pre-inflation to 38 ± 20% 10 mins post-inflation, SstO2-distal slowly and continuously desaturated and reach the nadir (16 ± 11%) toward the end of inflation. After deflation, SstO2-distal rapidly resaturated from 16 ± 11% to 91 ± 5% (i.e., hypersaturation); SstO2 monitored proximally to the tourniquet and on contralateral leg had significant but small desaturation (~ 2-3%, p < 0.001); in contrast, SctO2 remained stable. The desaturation load had a significant correlation with resaturation magnitude (p < 0.001); while the desaturation duration had a significant correlation with hypersaturation magnitude (p = 0.04). CONCLUSIONS Tissue dys-oxygenation following tourniquet application can be reliably monitored using tissue oximetry. Its outcome significance remains to be determined.
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Affiliation(s)
- Liang Lin
- Department of Anesthesiology, The First Affiliated Hospital, Xiamen University, Xiamen, Fujian Province, China
| | - Gang Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Jinlei Li
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06520, USA
| | - Lingzhong Meng
- Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, TMP 3, P.O. Box 208051, New Haven, CT, 06520, USA.
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Li XF, Wang ZQ, Li LY, Zhao GQ, Yu SN. Downregulation of the long noncoding RNA MBNL1-AS1 protects sevoflurane-pretreated mice against ischemia-reperfusion injury by targeting KCNMA1. Exp Mol Med 2018; 50:1-16. [PMID: 30185781 PMCID: PMC6123634 DOI: 10.1038/s12276-018-0133-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 04/28/2018] [Accepted: 05/24/2018] [Indexed: 01/19/2023] Open
Abstract
Total knee arthroplasty (TKA) is the most common and cost-effective treatment for older adults with long-standing osteoarthritis. During TKA, muscle cells suffer from prolonged oxygen deficiency, which leads to altered cell metabolism that reduces the energy demand and maintains cell homeostasis before blood flow is restored. This study focused on the role of the lncRNA muscleblind-like 1 antisense RNA 1 (MBNL1-AS1) in protecting sevoflurane-pretreated mice against ischemia-reperfusion (I/R) injury after TKA, as well as the elucidation of the potential associated mechanism. Identification of differentially expressed lncRNAs was performed using the microarray dataset GSE21164, which was extracted from the GEO database. Target genes of the lncRNA were determined using Multi-Experiment Matrix (MEM), a dual-luciferase reporter gene assay, and KEGG enrichment analyses. The results showed that MBNL1-AS1 was overexpressed in skeletal muscle cells in mice, while KCNMA1, which was enriched in the cGMP-PKG signaling pathway, was negatively regulated by MBNL1-AS1. Furthermore, I/R mice displayed serious inflammatory reactions. Down-regulation of MBNL1-AS1 increased the expression of KCNMA1, PKGII, VASP, VEGF, Bcl-2, Cyclin D1, Cyclin D3, and Cdc 42 but decreased the expression of Bax, cleaved caspase-3, and cleaved PARP. Furthermore, upon MBNL1-AS1 upregulation, the rate of cell apoptosis increased while the rate of cell proliferation decreased. Our data suggested that down-regulated lncRNA MBNL1-AS1 might promote the proliferation and inhibit the apoptosis of skeletal muscle cells by upregulating KCNMA1 expression via activation of the cGMP-PKG signaling pathway, thus protecting sevoflurane-pretreated mice against I/R injury after TKA. A potential therapeutic target identified by researchers in China could help limit damage to tissues following osteoarthritic knee surgery. A total knee arthroplasty can alleviate symptoms of end-stage osteoarthritis, but the surgery requires use of a tourniquet. This temporarily cuts blood supply to tissues and can trigger severe ischemia-reperfusion (I/R) injury, tissue damage caused by blood flow returning after oxygen deficiency. Shao-Nan Yu and co-workers at the China-Japan Union Hospital of Jilin University, Changchun, demonstrated that lowering expression of a particular RNA molecule following surgery could limit I/R damage. They found that the molecule was over-expressed in mice during I/R injury. This overexpression limited activation of a signalling pathway and an associated protein vital to the chemical balance of cell membranes and healthy muscle cell contraction.
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Affiliation(s)
- Xue-Feng Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, PR China
| | - Zong-Qiang Wang
- Medical Department, China-Japan Union Hospital of Jilin University, Changchun, 130033, PR China
| | - Long-Yun Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, PR China
| | - Guo-Qing Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, PR China
| | - Shao-Nan Yu
- Department of Radiology, China-Japan Union Hospital of Jilin University, Changchun, 130033, PR China.
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Žargi T, Drobnič M, Stražar K, Kacin A. Short-Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction. Front Physiol 2018; 9:1150. [PMID: 30197599 PMCID: PMC6118218 DOI: 10.3389/fphys.2018.01150] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/31/2018] [Indexed: 01/19/2023] Open
Abstract
Surgical ACL reconstruction performed with a tourniquet induces compression and ischemic stress of the quadriceps femoris (QF) muscle which can accelerate postoperative weakness. Given that low-load blood flow restricted (BFR) exercise is potent in enhancing muscle oxygenation and vascular function, we hypothesized that short-term preconditioning with low-load BFR exercise can attenuate QF muscle endurance deterioration in the postoperative period. Twenty subjects undergoing arthroscopic ACL reconstruction performed 5 exercise sessions in the last 8 days prior to surgery. They were assigned into either BFR group, performing low-load BFR knee-extension exercise, or SHAM-BFR group, replicating equal training volume with sham occlusion. Blood flow (near-infrared spectroscopy) and surface EMG of QF muscle during sustained isometric contraction at 30% of maximal voluntary isometric contraction (MVIC) torque performed to volitional failure were measured prior to the intervention and again 4 and 12 weeks after surgery. There was an overall decrease (p = 0.033) in MVIC torque over time, however, no significant time-group interaction was found. The time of sustained QF contraction shortened (p = 0.002) in SHAM-BFR group by 97 ± 85 s at week 4 and returned to preoperative values at week 12. No change in the time of sustained contraction was detected in BFR group at any time point after surgery. RMS EMG amplitude increased (p = 0.009) by 54 ± 58% at week 4 after surgery in BFR group only. BFm increased (p = 0.004) by 52 ± 47% in BFR group, and decreased (p = 0.023) by 32 ± 19% in SHAM-BFR group at week 4 after surgery. Multivariate regression models of postoperative changes in time of sustained QF contraction revealed its high correlation (R2 = 0.838; p < 0.001) with changes in BFm and RMS EMG in the SHAM-BFR group, whereas no such association was found in the BFR group. In conclusion, enhanced endurance of QF muscle was triggered by combination of augmented muscle fiber recruitment and enhanced muscle perfusion. The latter alludes to a preserving effect of preconditioning with BFR exercise on density and function of QF muscle microcirculation within the first 4 weeks after ACL reconstruction.
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Affiliation(s)
- Tina Žargi
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Matej Drobnič
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Klemen Stražar
- Department of Orthopedic Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Alan Kacin
- Department of Physiotherapy, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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De Smet S, D'Hulst G, Poffé C, Van Thienen R, Berardi E, Hespel P. High-intensity interval training in hypoxia does not affect muscle HIF responses to acute hypoxia in humans. Eur J Appl Physiol 2018; 118:847-862. [PMID: 29423544 DOI: 10.1007/s00421-018-3820-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 01/31/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE The myocellular response to hypoxia is primarily regulated by hypoxia-inducible factors (HIFs). HIFs thus conceivably are implicated in muscular adaptation to altitude training. Therefore, we investigated the effect of hypoxic versus normoxic training during a period of prolonged hypoxia ('living high') on muscle HIF activation during acute ischaemia. METHODS Ten young male volunteers lived in normobaric hypoxia for 5 weeks (5 days per week, ~ 15.5 h per day, FiO2: 16.4-14.0%). One leg was trained in hypoxia (TRHYP, 12.3% FiO2) whilst the other leg was trained in normoxia (TRNOR, 20.9% FiO2). Training sessions (3 per week) consisted of intermittent unilateral knee extensions at 20-25% of the 1-repetition maximum. Before and after the intervention, a 10-min arterial occlusion and reperfusion of the leg was performed. Muscle oxygenation status was continuously measured by near-infrared spectroscopy. Biopsies were taken from m. vastus lateralis before and at the end of the occlusion. RESULTS Irrespective of training, occlusion elevated the fraction of HIF-1α expressing myonuclei from ~ 54 to ~ 64% (P < 0.05). However, neither muscle HIF-1α or HIF-2α protein abundance, nor the expression of HIF-1α or downstream targets selected increased in any experimental condition. Training in both TRNOR and TRHYP raised muscular oxygen extraction rate upon occlusion by ~ 30%, whilst muscle hyperperfusion immediately following the occlusion increased by ~ 25% in either group (P < 0.05). CONCLUSION Ten minutes of arterial occlusion increased HIF-1α-expressing myonuclei. However, neither normoxic nor hypoxic training during 'living high' altered muscle HIF translocation, stabilisation, or transcription in response to acute hypoxia induced by arterial occlusion.
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Affiliation(s)
- Stefan De Smet
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium
| | - Gommaar D'Hulst
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium.,Laboratory of Exercise and Health, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Chiel Poffé
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium
| | - Ruud Van Thienen
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium
| | - Emanuele Berardi
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium
| | - Peter Hespel
- Exercise Physiology Research Group, Department of Movement Sciences, KU Leuven, Tervuursevest 101, 3001, Leuven, Belgium. .,Bakala Academy-Athletic Performance Center, KU Leuven, Leuven, Belgium.
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Kumar K, Railton C, Tawfic Q. Tourniquet application during anesthesia: "What we need to know?". J Anaesthesiol Clin Pharmacol 2016; 32:424-430. [PMID: 28096570 PMCID: PMC5187604 DOI: 10.4103/0970-9185.168174] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tourniquets are routinely and safely used in limb surgeries throughout the world. Tourniquet application alters normal physiology. Healthy patients tolerate these physiological changes well, but the physiological changes may not be well-tolerated by patients with poor cardiac function. This review discusses the physiological changes associated with tourniquet use, safe practice and provides the latest updates regarding tourniquet use. A systematic literature search of PubMed, MEDLINE, ScienceDirect, and Google Scholar was done. The search results were limited to the randomized controlled trials and systemic reviews. The papers are summarized in this review.
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Affiliation(s)
- Kamal Kumar
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, Western University, London Health Sciences, Victoria Hospital, London, Ontario, Canada
| | - Craig Railton
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, Western University, London Health Sciences, Victoria Hospital, London, Ontario, Canada
| | - Qutaiba Tawfic
- Department of Anesthesia and Perioperative Medicine, Schulich School of Medicine, Western University, London Health Sciences, Victoria Hospital, London, Ontario, Canada
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