Lactatanstieg nach hyperthermer Extremitätenperfusion — ein Maß für die intraoperative Muskelalteration

Omlor, G.; Ecker, K. W.; Gross, Gerd; Becker, Janne; Hülsewede, R.

doi:10.1007/978-3-642-75951-2_35

Cited by 1 publication

(2 citation statements)

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“…Die inad~iquate O2-Versorgung im Perfusionsgebiet fiugert sich in dem beschriebenen Anstieg des Serumlaktats nach Reperfusion. Omlor et al [22] fanden bei ILP mit Melphalan bei 10 Patienten ebenfalls einen Anstieg des Laktats am ersten postoperativen Tag, der mit der Gewebetemperatur korrelierte [22]. Die Autoren diskutierten als Ursache eine Muskelschgdigung wfihrend der Perfusion.…”

Section: Diskussionunclassified

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O2-Utilisation während und nach hyperthermer Extremitätenperfusion mit rhTNFα und Melphalan

Haier

Hohenberger

Beck

et al. 1997

Langenbecks Arch Chiv

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During isolated limb perfusion (ILP) severe metabolic impairment with a subsequent alteration in oxygen consumption can be observed. The mechanisms responsible for this may be extracorporeal circulation, hyperthermia, and application of cytostatic drugs and cytokines. Thirty-three patients underwent ILP with rhTNF alpha and melphalan for melanoma or soft-tissue sarcoma. Cardiopulmonary monitoring consisted of arterial and mixed venous blood-gas analysis and a Swan-Ganz catheter was inserted after induction of general anesthesia prior to any surgical intervention. Arterial (SaO2) and mixed venous (SvO2) oxygen saturation, serum lactate and end-expiratory CO2 concentration were determined peri- and postoperatively for 72 h. Oxygen supply and consumption rates were measured systemically (DO2I, VO2I) and in the extracorporeal circuit ('DO2I, 'VO2I). For statistical analysis we used the t-test. During extracorporal circulation an increase of DO2I and VO2I was observed. A slight increase of lactate values began during the wash-out phase. Immediately after reperfusion. DO2I, VO2I and lactate increased significantly with normalization until the 2nd postoperative day. SaO2 and SvO2 remained unchanged. A significant correlation between regional toxicity and the postoperative maximum of serum lactate values was found. The increase of DO2I and VO2I in the tissues during ILP and after reperfusion was achieved by a significant increase in cardiac output while the oxygen extraction rate was not altered. Elevation of lactate values after reperfusion and the increase in oxygen utilization might be due to oxygen depletion in the perfused limb. This could contribute to the development of lactacidosis or rhabdomyolysis. Therefore, to minimize toxicity it seems to be mandatory to measure adequate tissue oxygen supply during ILP.

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Section: Diskussionunclassified

“…Im Gegensatz zu unseren Messungen trat jedoch bei analoger Ausprggung eines Septic-shock-like-Syndromes eine anhaltende Reduktion der O2-Extraktion auf. Ursachen for den ver~nderten Sauerstoffbedarf k6nnen in der durch Hyperthermie alterierten Stoffwechselsituation, einer Zytokinfreisetzung oder der ver~inderten H~imdyna-mik liegen [5,22,24].…”

Section: Diskussionunclassified

O2-Utilisation während und nach hyperthermer Extremitätenperfusion mit rhTNFα und Melphalan

Haier

Hohenberger

Beck

et al. 1997

Langenbecks Arch Chiv

View full text Add to dashboard Cite

show abstract

Lactatanstieg nach hyperthermer Extremitätenperfusion — ein Maß für die intraoperative Muskelalteration

Cited by 1 publication

References 3 publications

O2-Utilisation während und nach hyperthermer Extremitätenperfusion mit rhTNFα und Melphalan

O2-Utilisation während und nach hyperthermer Extremitätenperfusion mit rhTNFα und Melphalan

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