Secondary Logo

Journal Logo

In Response

Govinda, Raghavendra; Sessler, Daniel I., MD; Akça, Ozan, MD

doi: 10.1213/ANE.0b013e3182161c0a
Letters to the Editor: Letters & Announcements
Free

Department of Anesthesiology Tufts Medical Center, Massachusetts Outcomes Research Consortium Cleveland, Ohio (Govinda)

Department of Outcomes Research Cleveland Clinic Cleveland, Ohio (Sessler)

Department of Anesthesiology & Perioperative Medicine Neuroscience ICU University of Louisville Louisville, Kentucky Outcomes Research Consortium Cleveland, Ohio ozan.akca@louisvlle.edu (Akça)

Ramarapu1 notes that we did not determine whether there were preoperative differences in tissue oxygen saturation at the surgical site, upper arm, and thenar eminence.2 However, tissue oxygenation in the upper arm and that adjacent to a surgical incision are similar.3 Furthermore, tissue oxygenation is similar in the upper arm and colon.4

The more interesting question, and one we addressed, is whether there is a meaningful association between tissue oxygen saturation and surgical site infection. There was, and our result is important because it suggests that interventions such as supplemental oxygen,5 vascular volume repletion,6 local7 and systemic8 warming, hypercarbia,9,10 and adequate analgesia,11 all known to improve tissue oxygenation, might reduce infectious complications. Whether these interventions actually reduce infectious risk remains to be determined in a randomized trial. Our results suggest that a trial would be well worthwhile.

Raghavendra Govinda, MD

Department of Anesthesiology

Tufts Medical Center, Massachusetts

Outcomes Research Consortium

Cleveland, Ohio

Daniel I. Sessler, MD

Department of Outcomes Research

Cleveland Clinic

Cleveland, Ohio

Ozan Akça,MD

Department of Anesthesiology & Perioperative Medicine

Neuroscience ICU

University of Louisville

Louisville, Kentucky

Outcomes Research Consortium

Cleveland, Ohio

ozan.akca@louisvlle.edu

Back to Top | Article Outline

REFERENCES

1. Ramarapu S. Early postoperative subcutaneous tissue oxygen predicts surgical site infection. Anesth Analg 2011; 112: 1510
2. Govinda R, Kasuya Y, Bala E, Mahboobi R, Devarajan J, Sessler DI, Akca O. Early postoperative subcutaneous tissue oxygen predicts surgical site infection. Anesth Analg 111: 946–52
3. Kabon B, Rozum R, Marschalek C, Prager G, Fleischmann E, Chiari A, Kurz A. Supplemental postoperative oxygen and tissue oxygen tension in morbidly obese patients. Obes Surg 2010; 20: 885–94
4. Fleischmann E, Herbst F, Kugener A, Kabon B, Niedermayr M, Sessler DI, Kurz A. Mild hypercapnia increases subcutaneous and colonic oxygen tension in patients given 80 inspired oxygen during abdominal surgery. Anesthesiology 2006; 104: 944–9
5. Greif R, Akça O, Horn E-P, Kurz A, Sessler DI. Outcomes Research™ group: supplemental perioperative oxygen to reduce the incidence of surgical wound infection. N Engl J Med 2000; 342: 161–7
6. Arkilic CF, Taguchi A, Sharma N, Ratnaraj J, Sessler DI, Read TE, Fleshman JW, Kurz A. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery 2003; 133: 49–55
7. Ikeda T, Tayefeh F, Sessler DI, Kurz A, Plattner O, Petschnigg B, Hopf HW, West J. Local radiant heating increases subcutaneous oxygen tension. Am J Surg 1998; 175: 33–7
8. Sheffield CW, Sessler DI, Hopf HW, Schroeder M, Moayeri A, Hunt TK, West JM. Centrally and locally mediated thermoregulatory responses alter subcutaneous oxygen tension. Wound Rep Reg 1997; 4: 339–45
9. Akça O, Doufas AG, Morioka N, Iscoe S, Fisher J, Sessler DI. Hypercapnia improves tissue oxygenation. Anesthesiology 2002; 97: 801–6
10. Akça O, Liem E, Suleman MI, Doufas AG, Galandiuk S, Sessler DI. Effect of intra-operative end-tidal carbon dioxide partial pressure on tissue oxygenation. Anaesthesia 2003; 58: 536–42
11. Akça O, Melischek M, Scheck T, Hellwagner K, Arkiliç C, Kurz A, Kapral S, Heinz T, Lackner FX, Sessler DI. Postoperative pain and subcutaneous oxygen tension. Lancet 1999; 354: 41–2
© 2011 International Anesthesia Research Society