Effects of upper limb ischemia-reperfusion on regional oxidative stress during aortic surgery with moderate hypothermia.


Balcı E(1), Demir ZA(2), Yiğit Özay H(1), Vardar K(3), Karduz G(3), Aksu U(3), Ünal EU(4), Özgök A(2).
Author information:
(1)Department of Anaesthesiology and Reanimation, Ankara City Hospital, Ankara, Turkey.
(2)Department of Anaesthesiology and Reanimation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
(3)Department of Biology, Faculty of Science, The University of Istanbul, Istanbul, Turkey.
(4)Department of Cardiovascular Surgery, Erol Olçok Hospital, Hitit University, Çorum, Turkey.


INTRODUCTION: This study aims to evaluate the effect of acute, iatrogenic right arm ischemia and reperfusion (I/R) due to right axillary cannulation on regional oxidative stress using tissue perfusion markers such as central venous oxygen saturation, lactate, the difference between central venous and arterial CO2 pressure, near-infrared spectroscopy (NIRS) measurements, 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 the axillary artery participated. Blood samples were collected from the internal jugular vein, right arm cubital vein, and left arm cubital vein, and analysis was performed at intraoperative time points. RESULTS: Right-arm venous oxygen saturation levels are significantly lower than left arm and central venous, as expected in iatrogenic ischemia. Right arm lactate levels are significantly higher. Somatic right arm NIRS 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 reflect the results of ischemia-reperfusion more rapidly, and are more valuable than novel biomarkers. NIRS is a promising monitor in terms of providing information about tissue oxygenation. Oxidative stress biomarkers do not change quickly enough to give useful information in a short enough period of time; moreover, their costs are high and laboratory studies take time. Although axillary cannulation is controlled limb ischemia, the local effects of I/R did not completely normalize at the end of the surgery, and this regional I/R did not affect the global body organism.