Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue

Background and purpose — Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. We evaluated the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous b...

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Autores principales:	Pelle Hanberg, Mats Bue, Jesper Kabel, Andrea René Jørgensen, Christian Jessen, Kjeld Søballe, Maiken Stilling
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2021
Materias:	Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/18ff7068155e4d00a8cf94642b5dd729
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spelling	oai:doaj.org-article:18ff7068155e4d00a8cf94642b5dd7292021-11-26T11:19:48ZEffects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue1745-36741745-368210.1080/17453674.2021.1942620https://doaj.org/article/18ff7068155e4d00a8cf94642b5dd7292021-10-01T00:00:00Zhttp://dx.doi.org/10.1080/17453674.2021.1942620https://doaj.org/toc/1745-3674https://doaj.org/toc/1745-3682Background and purpose — Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. We evaluated the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous bone, and plasma. The primary endpoint was the time for which the free cefuroxime concentration was maintained above the clinical breakpoint minimal inhibitory concentration (T > MIC) for Staphylococcus aureus (4 µg/mL). Patients and methods — 10 patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed for sampling of cefuroxime concentrations bilaterally in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the thigh of the leg scheduled for surgery (tourniquet duration time [range]: 65 minutes [58–77]). Cefuroxime (1.5 g) was administered intravenously 15 minutes prior to tourniquet inflation, followed by a second dose 6 hours later. Dialysates and venous blood samples were collected for 12 hours. Results — A cefuroxime concentration of 4 µg/mL was reached within 23 minutes in all compartments and patients. For cefuroxime the T > MIC (4 µg/mL) ranged between 4.8 and 5.4 hours across compartments, with similar results for the tourniquet and non-tourniquet leg. Comparable T > MIC and penetration ratios were found for the first and second dosing intervals. Interpretation — Administration of cefuroxime (1.5 g) 15 minutes prior to tourniquet inflation is safe in order to achieve tissue concentrations above 4 µg/mL throughout surgery. A tourniquet application time of approximately 1 hour did not affect the cefuroxime tissue penetration in the following dosing interval.Pelle HanbergMats BueJesper KabelAndrea René JørgensenChristian JessenKjeld SøballeMaiken StillingTaylor & Francis GrouparticleOrthopedic surgeryRD701-811ENActa Orthopaedica, Vol 92, Iss 6, Pp 746-752 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Orthopedic surgery RD701-811
spellingShingle	Orthopedic surgery RD701-811 Pelle Hanberg Mats Bue Jesper Kabel Andrea René Jørgensen Christian Jessen Kjeld Søballe Maiken Stilling Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue
description	Background and purpose — Tourniquet is widely used in orthopedic surgery to reduce intraoperative bleeding and improve visualization. We evaluated the effect of tourniquet application on peri- and postoperative cefuroxime concentrations in subcutaneous tissue, skeletal muscle, calcaneal cancellous bone, and plasma. The primary endpoint was the time for which the free cefuroxime concentration was maintained above the clinical breakpoint minimal inhibitory concentration (T > MIC) for Staphylococcus aureus (4 µg/mL). Patients and methods — 10 patients scheduled for hallux valgus or hallux rigidus surgery were included. Microdialysis catheters were placed for sampling of cefuroxime concentrations bilaterally in subcutaneous tissue, skeletal muscle, and calcaneal cancellous bone. A tourniquet was applied on the thigh of the leg scheduled for surgery (tourniquet duration time [range]: 65 minutes [58–77]). Cefuroxime (1.5 g) was administered intravenously 15 minutes prior to tourniquet inflation, followed by a second dose 6 hours later. Dialysates and venous blood samples were collected for 12 hours. Results — A cefuroxime concentration of 4 µg/mL was reached within 23 minutes in all compartments and patients. For cefuroxime the T > MIC (4 µg/mL) ranged between 4.8 and 5.4 hours across compartments, with similar results for the tourniquet and non-tourniquet leg. Comparable T > MIC and penetration ratios were found for the first and second dosing intervals. Interpretation — Administration of cefuroxime (1.5 g) 15 minutes prior to tourniquet inflation is safe in order to achieve tissue concentrations above 4 µg/mL throughout surgery. A tourniquet application time of approximately 1 hour did not affect the cefuroxime tissue penetration in the following dosing interval.
format	article
author	Pelle Hanberg Mats Bue Jesper Kabel Andrea René Jørgensen Christian Jessen Kjeld Søballe Maiken Stilling
author_facet	Pelle Hanberg Mats Bue Jesper Kabel Andrea René Jørgensen Christian Jessen Kjeld Søballe Maiken Stilling
author_sort	Pelle Hanberg
title	Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue
title_short	Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue
title_full	Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue
title_fullStr	Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue
title_full_unstemmed	Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue
title_sort	effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue
publisher	Taylor & Francis Group
publishDate	2021
url	https://doaj.org/article/18ff7068155e4d00a8cf94642b5dd729
work_keys_str_mv	AT pellehanberg effectsoftourniquetinflationonperiandpostoperativecefuroximeconcentrationsinboneandtissue AT matsbue effectsoftourniquetinflationonperiandpostoperativecefuroximeconcentrationsinboneandtissue AT jesperkabel effectsoftourniquetinflationonperiandpostoperativecefuroximeconcentrationsinboneandtissue AT andrearenejørgensen effectsoftourniquetinflationonperiandpostoperativecefuroximeconcentrationsinboneandtissue AT christianjessen effectsoftourniquetinflationonperiandpostoperativecefuroximeconcentrationsinboneandtissue AT kjeldsøballe effectsoftourniquetinflationonperiandpostoperativecefuroximeconcentrationsinboneandtissue AT maikenstilling effectsoftourniquetinflationonperiandpostoperativecefuroximeconcentrationsinboneandtissue
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Effects of tourniquet inflation on peri- and postoperative cefuroxime concentrations in bone and tissue

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