Background: Major vascular surgery with aortic cross-clamping is
associated with temporary ischaemia of the lower limb due to lack of tissue blood
flow. The present study was designed to determine if the short-term changes in
cellular metabolism occurring during this situation can be detected by subcutaneous
microdialysis. It was also hoped to ascertain if this new technique is useful in the
continuous bedside monitoring of metabolism during aortic surgery.
Methods: In a controlled clinical study 20 patients undergoing elective
aortic surgery were monitored using microdialysis probes that were inserted in the
subcutaneous tissue of the left lower limb and a non-ischaemic region (shoulder).
Interstitial fluid was obtained and the concentrations of glucose and lactate during
lower limb ischaemia and during reperfusion were measured and compared with
concentrations observed in fluid obtained from the non-ischaemic control tissue.
Results: Circulatory occlusion caused an immediate and significant
decrease in the glucose/lactate ratio from 3·1±1·3 to 0·48±0·5 (P<0·05) that
returned to preocclusion values within 2 h of commencing reperfusion.
Conclusion: We suggest that microdialysis may be used both to assess
acute changes in tissue metabolism during ischaemic periods and also to act as an
additional tool for the detection of peri-operative acute variations in limb blood
flow.
