Abstract
Purpose: Near-infrared spectroscopy (NIRS) detects changes in chromophore concentrations of oxygenated (O2Hb) and deoxygenated hemoglobin (HHb) in target tissues approximately 2 to 3 cm below the skin. The main purpose of this study was to non-invasively measure skeletal muscle oxygenation in the leg during and after tourniquet (TQ)-induced ischemia using continuous wave NIRS. Secondarily, we aimed to assess the sensitivity, specificity, and reliability of this optical technique for detection and continuous monitoring of changes in muscle oxygenation and hemodynamics during TQ-induced ischemia throughout orthopedic surgery.
Method: Consented patients aged 19–69 (n=21) with unilateral ankle fracture requiring emergency or elective surgery at our institution were recruited. All patients underwent standard general anesthetic. A pair of NIRS probes was fixed over the midpoint of the tibialis anterior muscle (TA) of both the fractured and healthy legs. A thigh TQ was applied to the injured leg and inflated to 300 mmHg. Using the NIRS apparatus coupled to a laptop with data acquisition software, changes in O2Hb, HHb, and total hemoglobin (tHb) levels in the TAs of both legs were measured at 10 Hz before and during TQ inflation, and after release until values returned to baseline. In each surgery the TQ was released when arterial obstruction was no longer required by the clinical team. Data are reported as mean±SD.
Results: Changes in O2Hb, HHb, and tHb were successfully collected, stored and transmitted for graphic display in all subjects. TQ time (ischemia interval) varied among subjects, from 1245 s to 4431 s (2753±854). NIRS measured a progressive increase in HHb (2.6±2 μmol/L) during the first minute of TQ inflation and a sharp increase in O2Hb (23.3±12 μmol/L) during the first minute of leg muscle reperfusion (after deflation). Following TQ inflation a progressive increase in HHb (24.2±10.3 μmol/L) with a concomitant decrease in O2Hb (mean – 24.4±8 μmol/L) in the under-TQ TA were consistent across subjects. These changes in ΔHHb and ΔO2Hb began to reverse immediately after TQ deflation. Significant correlations were observed between ischemia interval and, respectively, oxygenation recovery time (r2=0.84) and changes of deoxygenated hemoglobin (r2=0.57).
Conclusion: We demonstrated that, following TQ inflation and deflation respectively, NIRS can sensitively monitor muscle deoxygenation and reoxygenation. Consistent patterns of ΔHHb and ΔO2Hb occurred during TQ-induced ischemia in all subjects. These data confirm that near infrared spectroscopy is useful for the non-invasive detection and monitoring of muscle ischemia. These results indicate that it may be useful to investigate the efficacy of NIRS in the early detection of muscle ischemia or hypoxemia in conditions such as compartment syndrome.
FUNDING: MSFHR, COF, BC Lung.
Correspondence should be addressed to: COA, 4150 Ste. Catherine St. West Suite 360, Westmount, QC H3Z 2Y5, Canada. Email: meetings@canorth.org
