The acute effects of tourniquet ischemia on tissue and blood gas tensions in the primate limb

Miller, Stephen H.; Lung, Richard J.; Graham, William P.; Davis, T. W.; Rusenas, Irena

doi:10.1016/s0363-5023(78)80113-0

Cited by 27 publications

(8 citation statements)

References 18 publications

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“…We hypothesized that this resulted from an active blood flow that caused an outflow of the deoxy-Hb enriched erythrocytes, which were then deoxygenated by the transcutaneously absorbed CO 2 , as well as by an inflow of the oxy-Hb enriched normal erythrocytes. Therefore, we employed a pneumatic tourniquet (commonly used in a number of surgeries) [24], [25] to halt the blood flow and keep the erythrocytes in the arm during the transcutaneous CO 2 application. In addition, the pneumatic tourniquet reduced the problems inherent in measuring the O 2 dissociation from the Hb, for example, by an increase in local tissue temperature caused by a hypercapnia-induced increase in blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…The O 2 dissociation curve of myoglobin is a rectangular hyperbola, and myoglobin releases oxygen at a very low pO 2 [27], as P 50 of myoglobin is 2.03 mmHg at 35°C [28]. In a previous report, tissue pO 2 was shown to be about 25–45 mmHg with blood pooling by applying a pneumatic tourniquet for 10–20 min [24], [25]. In addition, the relationship of myoglobin P 50 with pH is linear [28].…”

Section: Discussionmentioning

confidence: 99%

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A Novel System for Transcutaneous Application of Carbon Dioxide Causing an “Artificial Bohr Effect” in the Human Body

Sakai

Miwa

et al. 2011

PLoS ONE

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BackgroundCarbon dioxide (CO2) therapy refers to the transcutaneous administration of CO2 for therapeutic purposes. This effect has been explained by an increase in the pressure of O2 in tissues known as the Bohr effect. However, there have been no reports investigating the oxygen dissociation of haemoglobin (Hb) during transcutaneous application of CO2 in vivo. In this study, we investigate whether the Bohr effect is caused by transcutaneous application of CO2 in human living body.MethodsWe used a novel system for transcutaneous application of CO2 using pure CO2 gas, hydrogel, and a plastic adaptor. The validity of the CO2 hydrogel was confirmed in vitro using a measuring device for transcutaneous CO2 absorption using rat skin. Next, we measured the pH change in the human triceps surae muscle during transcutaneous application of CO2 using phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in vivo. In addition, oxy- and deoxy-Hb concentrations were measured with near-infrared spectroscopy in the human arm with occulted blood flow to investigate O2 dissociation from Hb caused by transcutaneous application of CO2.ResultsThe rat skin experiment showed that CO2 hydrogel enhanced CO2 gas permeation through the rat skin. The intracellular pH of the triceps surae muscle decreased significantly 10 min. after transcutaneous application of CO2. The NIRS data show the oxy-Hb concentration decreased significantly 4 min. after CO2 application, and deoxy-Hb concentration increased significantly 2 min. after CO2 application in the CO2-applied group compared to the control group. Oxy-Hb concentration significantly decreased while deoxy-Hb concentration significantly increased after transcutaneous CO2 application.ConclusionsOur novel transcutaneous CO2 application facilitated an O2 dissociation from Hb in the human body, thus providing evidence of the Bohr effect in vivo.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Novel System for Transcutaneous Application of Carbon Dioxide Causing an “Artificial Bohr Effect” in the Human Body

Sakai

Miwa

et al. 2011

PLoS ONE

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“…7,31 Similarly, arteriovenous shunting, which permits little or no oxygen diffusion between capillaries and tissue, has been described after tourniquet release. 7,10,11 Rutherford, Webb, and Hardaway have explored the question of coagulation changes during acidosis. [32][33][34] They showed that severe acidosis produced by hemorrhagic shock produces dramatic changes in the ability of blood to coagulate.…”

Section: Discussionmentioning

confidence: 99%

“…Measurements of blood pH constitute the best method of assaying the degree of acidosis and cellular hypoxia, with a low pH indicating acidosis . To minimize morbidity associated with traumatism or any kind of injuries, digital tourniquets are necessary to provide a bloodless environment to facilitate exploration, surgical exposure, accurate tissue identification, and identification of deep tissue injuries and foreign bodies .…”

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confidence: 99%

Effects of Digital Tourniquet Ischemia: A Single Center Study

Becerro-de-Bengoa-Vallejo

Iglesias

López‐López

et al. 2013

Dermatologic Surgery

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Tourniquet application time is precious. While operating under tourniquet control, the extremity becomes increasingly acidotic. Tourniquet ischemia longer than 20 minutes causes local acidosis and muscle fatigue. Women and persons who weighed less could reach acidotic pH values faster than men or heavier patients. If applications longer than 20 minute are expected, the tourniquet should be released at 20 minutes, allowing the finger to reperfuse for 3-5 minutes to clear the acidosis before reapplication of tourniquet.

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“…Ames et al, 7 in 1968, first described a no-reflow phenomenon in areas of ischemic brain. Miller et al 23 observed that arteriovenous shuntings occurred in replanted limbs, and this could also reduce blood flow. May et al 6 mentioned that stasis and loss of intravascular fluid with consequent exposure of subintimal collagen could lead to thrombosis after replantation.…”

Section: Discussionmentioning

confidence: 99%

Study of Warm Ischemia Followed by Reperfusion on a Lower Limb Model in Rats: Effect of Allopurinol and Streptokinase

Cunha

Silva

Nakamoto

et al. 2005

Clinics

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MC. Study of warm ischemia followed by reperfusion on a lower limb model in rats: effect of allopurinol and streptokinase. Clinics. 2005;60(3):213-20. Prolonged tissue ischemia leads to changes in microcirculation and production of oxygen free radicals. The event eventually responsible for tissue death is the no-reflow phenomenon and its management is a challenge for the surgeon dealing with replantation or transplantation. We introduce a model of warm ischemia and reperfusion of the lower limb of rats with which we studied the effect of allopurinol and streptokinase. METHOD: Section of the lower limb with preservation of vessels and nerves was performed in 110 rats. Femoral vessels clamped for periods of 0, 2, 4, 6, and 8 hours of ischemia were allowed to reperfuse (groups M0, M2, M4, M6, and M8 respectively). Other groups, E1, E2, and E3, received streptokinase, allopurinol, or a combination of the two drugs after 6 hours of ischemia. RESULTS: Viability rates of the ischemic limbs after 7 days were 100% (M0), 80% (M2), 63.6% (M4), 50% (M6), and 20% (M8). In the experimental groups, E1, E2, and E3, viability rates were 67% (E1), 70% (E2), and 70% (E3). Groups M0, M2, M4, M6, and M8 differed among themselves except for groups M4 and M6. Group E1 had a higher rate of limb viability than M6 (control group) but not than M4. Groups E1, E2 and E3 had higher rates of limb viability than M6 but not than M2 or M4. DISCUSSION: The results suggest that increased viability of limbs after 6 hours of ischemia occurs when allopurinol or streptokinase is used. The combination of the two drugs does not appear to produce any additional effect.

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The acute effects of tourniquet ischemia on tissue and blood gas tensions in the primate limb

Cited by 27 publications

References 18 publications

A Novel System for Transcutaneous Application of Carbon Dioxide Causing an “Artificial Bohr Effect” in the Human Body

A Novel System for Transcutaneous Application of Carbon Dioxide Causing an “Artificial Bohr Effect” in the Human Body

Effects of Digital Tourniquet Ischemia: A Single Center Study

Study of Warm Ischemia Followed by Reperfusion on a Lower Limb Model in Rats: Effect of Allopurinol and Streptokinase

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