Uterine Reperfusion Ischemia and Use of Elastic Tourniquet

Abstract

Introduction: In humans, it has not been established that the use of elastic tourniquet (ET) during myomectomies, whose delivery times do not exceed 90 minutes, which is responsible for ischemia reperfusion (I/R) systemic. Objectives: To study the plasma variations of markers of I/R during myomectomies performed with ET, whose exposure time does not exceed 90 minutes. Population and methods: Plasma créatinin phosphokinase kinase (CPK) and gluthatione peroxydase (GPX) levels of patients with ET myoma (M + G +, n = 19), taken before, during and after exposure, were compared to those of women operated on myoma without tourniquet (M + G -, n = 15), carriers of unoperated myomas (M + G0, n = 20) and controls (M0G0, n = 18). The duration of exposure of the ET was determined, and perioperative variations of GPX, Ca2+, K+ and CPK between M + G + and others groups were analyzed (p Results: The average duration of exposure of the ET was 51.56 ± 14.12 [30 - 88] min. In M + G +, prior to insertion, CPK was 71.64, GPX 3.537, Ca2+ 3.000, K+ 3.934, and did not vary from those of M + G - (CPK = 59.354, GPX = 3.205, Ca2+ = 2.525, K+ = 3.788), M + G0 (CPK = 71.640, GPX = 2.759, Ca2+ = 3.004, K+ = 3.934) and M0G0 (CPK = 57.2, GPX = 2.306, Ca2+ = 2.879, K+ = 3.705). Conversely, during the posture (CPK = 95.665, GPX = 3.645, Ca2+ = 3.642, K+ = 4.757) and after the release of the ET (CPK = 135.443, GPX = 3.694, Ca2+ = 3.892, K+ = 5.322), these rates were higher among the M + G + compared to the M + G0 and M0G0, but did not differ from those of the M + G - during (CPK = 91.270, GPX = 3.413, Ca2+ = 3.068, K+ = 4.257) and after release (CPK = 137.776, GPX = 3.632, Ca2+ = 3.148, K+ = 5.075). Conclusion: The plasmatic concentration of ischemia (CPK, K+) and reperfusion (GPX, Ca2+) biomarkers does not differ between M + G + and M + G -, but is elevated relatively to controls (M0G0), but also to M + G0’s group. These results show that, for exposure times not exceeding 90 minutes, the elastic tourniquet is probably not the cause of the increase in plasma I/R markers observed in M + G + women. Moreover, these data suggest that the variations of the markers observed during the different surgical stages within each of the two groups of women M + G + and M + G - compared to those of the controls (M0G0) and unoperated myomas (M + G0) are due essentially to the surgical act.