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Blood Transfusions May Have Limited Effect on Muscle Oxygenation After Total Knee Arthroplasty

HSS Journal - Volume 11, Number 2, July 2015

Daniel Yoo, MB
Department of Anesthesiology, Hospital for Special Surgery, New York, NY

Kara G. Fields, MS
Healthcare Research Institute, Hospital for Special Surgery, New York, NY

Thomas Danninger, MD
Department of Anesthesiology, State Hospital of Salzburg, Salzburg, Austria

Ottokar Stundner, MD
Department of Anesthesiology, State Hospital of Salzburg, Salzburg, Austria

Isabelle Kao, BS
College of Medicine, SUNY Downstate Medical Center, New York, NY

Stephen O. Heard, MD
Department of Anesthesiology, UMass Memorial Medical Center, Worcester, MA

J. Matthias Walz, MD, FCCP
Department of Anesthesiology, UMass Memorial Medical Center, Worcester, MA

Image - Photo of Stavros G. Memtsoudis, MD, PhD
Stavros G. Memtsoudis, MD, PhD
Attending Anesthesiologist, Hospital for Special Surgery
Clinical Professor of Anesthesiology, Weill Cornell Medical College
Image - Photo of Federico P. Girardi, MD
Federico P. Girardi, MD

Attending Orthopaedic Surgeon, Hospital for Special Surgery
Professor of Orthopaedic Surgery, Weill Cornell Medical College
Associate Scientist, Research Division, Hospital for Special Surgery

Image - Photo of Friedrich Boettner, MD
Friedrich Boettner, MD
Associate Attending Orthopaedic Surgeon, Hospital for Special Surgery
Associate Professor of Orthopaedic Surgery, Weill Cornell Medical College
Image - Photo of Michael K. Urban, MD, PhD
Michael K. Urban, MD, PhD
Associate Attending Anesthesiologist, Hospital for Special Surgery

Abstract

Background
Traditionally, blood transfusions in the perioperative setting are used to maintain adequate delivery of nutrients and oxygen to organs. However, the effect of blood administration on tissue oxygenation in the perioperative setting remains poorly understood.

Questions/Purposes
The aim of this study was to determine changes in muscle tissue oxygenation saturation (SmO2) in response to perioperative blood transfusions.

Patients and Methods
Patients undergoing total knee arthroplasty were enrolled. SmO2, continuous hemoglobin (SpHb), stroke volume (SV), cardiac index, and standard hemodynamic parameters including heart rate (HR), mean arterial blood pressure (MAP), and arterial oxygen saturation (SO2) were recorded. To assess fluid responsiveness, a passive leg raise (PLR) test was performed before the transfusions were started.

Results
Twenty-eight patients were included in the analysis. Mean (±SD) SmO2 before transfusion was 63.18 ± 10.04%, SpHb was 9.27 ± 1.16 g/dl, and cardiac index was 2.62 ± 0.75 L/min/m2. A significant increase during the course of blood transfusion was found for SmO2 (+3.44 ± 5.81% [95% confidence interval (CI) 1.04 to 5.84], p = 0.007), SpHb (0.74 ± 0.92 g/dl [95% CI 0.35 to 1.12], p < 0.001), and cardiac index (0.38 ± 0.51 L/min/m2 [95% CI 0.15 to 0.60], p = 0.002), respectively. However, the correlation between SmO2 and SpHb over the course of the transfusion was negligible (ρ = 0.25 [95% CI −0.03 to 0.48]). A similar lack of correlation was found when analyzing data of those patients who showed a positive leg raise test before the start of the transfusion (ρ = 0.37 [95% CI −0.11 to 0.84]). 

Conclusion
We detected a statistically significant increase in SmO2 during the course of a single unit blood transfusion compared to baseline. However, there was no evidence of a correlation between longitudinal SmO2 and SpHb measurements.

Level of Evidence: Level IV - Prognostic Study

This article appears in the HSS Journal: Volume 11, Issue 2.
View the full HSS Journal article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.

 

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