Effects of Upper Limb Ischemia-Reperfusion on Regional Oxidative Stress
During Aortic Surgery with Moderate Hypothermia
Abstract
INTRODUCTION: The aim of this study is to evaluate the effect of acute,
iatrogenic right arm ischemia and reperfusion on microcirculation using
tissue perfusion markers like central venous oxygen saturation, lactate,
the difference between central venous and arterial CO2 pressure,
Near-infrared spectroscopy, and biomarkers like sialic acid,
malondialdehyde, advanced oxidative protein products in aortic surgery
with moderate hypothermia. METHODS: Adult patients undergoing ascending
aorta repair with antegrade cerebral perfusion via axillary artery
participated in the study. Blood samples were collected from the radial
artery, internal juguler vein, right arm cubital vein and left arm
cubital vein and analysis were performed at five intraoperative time
points. Blood samples for biomarkers were obtained at three
intraoperative time points. RESULTS: Right arm venous oxygen saturation
are significantly lower than left arm and central venous. Right arm
lactate levels are significantly higher than left arm and central venous
lactate levels. Somatic right arm near-infrared spectroscopy values are
significantly lower than somatic left arm. There are no significant
differences for biomarkers throughout the time points. CONCLUSIONS: We
have concluded that well-known markers such as central venous oxygen
saturation and lactate reflect the results of ischemia-reperfusion
faster, and are more valuable than novel biomarkers. Near-infrared
spectroscopy is a promising monitor in terms of providing information
about tissue oxygenation. However, oxidative stress biomarkers seem to
be far from following the results of ischemia-reperfusion damage in an
instant or short time, moreover, their costs are high and laboratory
studies take time.