The Effect of Anesthetic Technique on Hemodynamic Parametres in Total Knee Surgery

Öz

Objective: To compare the effects of spinal and general anaesthesia on hemodynamic variations during tourniquet application and cementation in patients undergoing total knee surgery. Materials and Methods: 38 ASA physical status I/II patients undergoing total knee surgery were randomized into two groups as spinal anesthesia group (n=18) where 3 mL of 0.5% levobupivacaine injected intrathecally and sevoflurane based general anesthesia group (n=20). Radial artery catheterization was performed in all of the patients and cardiac output, invasive arterial pressure and heart rate were measured and recorded before anesthesia indication or spinal blockade, at 5 th, 10 th, and 15 th min following endotracheal intubation or spinal blockade, just before and after tourniquet inflation, just before and at 1 st, 3 rd, 5 th, and 10 th min following bone cement placement, and at 1st min after tourniquet deflation. Results: Tourniquet application caused a significant increase in the blood pressure and cardiac output when compared to the values recorded before anesthesia in both groups. Sementation and deflation of the tourniquet caused decrease in blood pressure in both groups, but there was no significant difference between two groups. Conclusion: We concluded that total knee surgery with sementation and tourniquet application did not affect hemodynamic parameters in both spinal and general anesthesia groups.

Anahtar Kelimeler

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Diz Protezi Operasyonlarında Anestezi Yönteminin Hemodinami Üzerine Etkileri

Öz

Amaç: Diz protezi ameliyatlarında spinal ve genel anestezi yöntemlerinin metil metakrilat uygulaması, turnike şişirilmesi ve turnike indirilmesi sırasındaki hemodinamik değişiklikler üzerine olan etkilerini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Total diz protezi cerrahisi yapılacak olan ASA I/II grubu 38 hasta randomize olarak sevofluran bazlı genel anestezi (n=20) ve 3 mL %0.5 levobupivakainin intratekal olarak uygulandığı spinal anestezi (n=18) grubu olmak üzere iki gruba ayrıldı. Tüm hastalara radial arter kateterizasyonu yapıldıktan sonra kardiyak output, arteriyel kan basınçları ve kalp atım hızı anestezi indüksiyonu veya spinal anestezi öncesi, entübasyon veya spinal anestezi sonrası 5, 10, 15. dakikalarda, turnike öncesi, turnike sonrası, kemik çimento öncesi ve sonrası 1, 3, 5, 10. dakikalarda ve turnike indirildikten 1 dakika sonra ölçülerek kaydedildi. Bulgular: Spinal anestezi ve genel anestezi grubunda turnike uygulaması kardiyak outputta ve kan basıncında anestezi öncesi değerlerine göre anlamlı olarak artışa sebep oldu. Kemik çimentosu uygulaması ve turnike çözülmesi her iki grupta kardiyak outputu ve kan basıncını düşürdü, ancak gruplar arası anlamlı bir farklılık bulunamadı. Sonuç: Turnike ve kemik çimentosu uygulanan diz protezi operasyonlarında uygulanan anestezi yöntemlerinin hemodinamik açıdan birbirinden farklı olmadığı sonucuna vardık.

Anahtar Kelimeler

• Spinal anestezi, diz protez replasmanı, turnike, genel anestezi, kemik çimentosu, kardiyak output, hemodinami

Kaynakça

1. Breed AL. Experimental production of vascular hypotension, and bone marrow and fat embolism with methylmethacrylate cement. Traumatic hypertension of bone. Clin Orthop Relat Res 1974; 102: 227-244.
2. Ling RS, James ML. Blood pressure and bone cement. Br Med J 1971; 2: 404.
3. McCaskie AW, Barnes MR, Lin E, Harper WM, Gregg PJ. Cement pressurisation during hip replacement. J Bone Joint Surg Br 1997; 79: 379-384.
4. Phillips H, Cole PV, Lettin AW. Cardiovascular effects of implanted acrylic bone cement. Br Med J 1971; 3: 460-461.
5. Clark DI, Ahmed AB, Baxendale BR, Moran CG. Cardiac output during hemiarthroplasty of the hip. A prospective, controlled trial of cemented and uncemented prostheses. J Bone Joint Surg Br 2001; 83: 414-418.
6. Wheelwright EF, Byrick RJ, Wigglesworth DF, et al. Hypotension during cemented arthroplasty. Relationship to cardiac output and fat embolism. J Bone Joint Surg Br 1993; 75: 715-723.
7. Button D, Weibel L, Reuthebuch O, et al. Clinical evaluation of the FloTrac/Vigileo system and two established continous cardiac output monitoring devices in patients undergoing cardiac surgery. Br J Anaesth 2007; 99: 329-336.
8. Sharrock NE, Savarese JJ. Anesthesia for orthopedic surgery. In: Miller RD (editor) Anesthesia. 5. baskı, New York: Churchill Livingston. 2000; 2118-2136.

9. Kaufman RD, Walts LF. Tourniquet-induced hypertension. Br J Anaesth 1982; 54: 333-336.
10. Valli H, Rosenberg PH, Kytta J, Nurminen M. Arterial hypertension associated with the use of a tourniquet with either general or regional anaesthesia. Acta Anaesthesiol Scand 1987; 31: 279-283.
11. Girardis M, Milesi S, Donato S, et al. The hemodynamic and metabolic effects of tourniquet application during knee surgery. Anesth Analg 2000; 91: 727-731.
12. Kabukçu HK, Özdemir H, Şahin N, Titiz TA. Diz Artroskopisinde Spinal Anestezi Altında Turnike Uygulanması- nın Hemodinamik ve Metabolik Etkileri. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 2004; 57: 13-18.
13. Honarmand A, Safavi MR. Preoperative oral dextrometorphan vs. clonidine to prevent tourniquet-induced cardiovascular responses in orthopaedic patients under general anaesthesia. Eur J Anaesth 2007; 24: 511-515.
14. Tetzlaff JE, O’Hara J, Yoon HJ, Schubert A. Tourniquet- induced hypertension correlates with autonomic nervous system changes detected by power spectral heart rate analysis. J Clin Anesth 1997; 9: 138-142.
15. Valli H, Rosenberg PH. Effects of three anaesthesia methods on haemodynamic responses connected with the use of thigh tourniquet in orthopaedic patients. Acta Anaesthesiol Scand 1985; 29: 142-147.
16. Modig J, Kolstad K, Wigren A. Systemic reactions to tourniquet ischaemia. Acta Anaesthesiol Scand 1978; 22: 609-614.
17. Kabul Tarihi: 22.03.2010