Detection and monitoring of tissue ischemia due to acute arterial obstruction in the limbs of patients with quantitative violations in consciousness, peridural anesthesia

Traced and interpreted is the dynamic and correlative relations between the values of certain biochemical parameters of the homeostasis connected with cell metabolism in skeletal muscles so a verification of tissue ischemia (TI) and ischemic tissue lesion (ITL) can be performed. The target group is patients with quantitative violations in consciousness and peridural catheters placed for anesthesia, with the suspicion that an acute arterial obstruction in the limbs (AAOL) has occurred, or one has already been verified. Test of the serum levels of CK; CK (MB); ASAT; ALAT and Myoglobin were initially performed and were monitored in dynamic. A valuation of the ASAT/ALAT index in close correlation with the other parameters and clinical course of the disease was also performed. A particular dynamic and correlation, before the operation, after the timely revascularization, during the development of ischemic gangrene and after the amputation on an optimal level, was observed. We found an acute elevation of the enzyme activity of CK; CK (MB) and ASAT in the case of AAOL which generated TI. ALAT and Myoglobin remained in the reference ranges. In cases with unsuccessful, late or impossible revascularization and transition to TI and ITL (ischemic rhabdomyolysis) we found progressive elevation in the levels of the parameters being monitored, including ALAT and Myoglobin. The registered values, in the patients who were not operated, before death, were 900 times above for CK, and CK (MB) did not exceed 5% of CK. Over 100 times the standard value for ASAT and ALAT without and hepatic pathology and acute coronary incident. The ASAT/ALAT index is extremely positive in the group with ITL. The registered values of serum Myoglobin reached up to 70 times above the reference range. Upon, revascularization, amputation on an optimal level or an experienced gangrene, a rapid decrease in the values to the reference range for a period 24-48 hours, was observed, except for ALAT, it normalized after 2-3 days. In cases with ischemic gangrene the ASAT/ALAT index from extremely positive in the beginning (>3.0-5.0) progressively decreased due to the rapid elevation of the values of ALAT with permanently high ASAT. The significant changes and correlative relations of the monitored parameters have distinct differences in cases with reversible TI and irreversible ITL, forming typical laboratory constellations in all of the controlled cases. This gives sufficient reason to believe that the implemented approach can form the basis of an objective method for early detection and monitoring of TI and ischemic tissue damage in AAOL in the target patient population for good clinical practice.