Korean J Anesthesiol.  1999 Apr;36(4):653-659. 10.4097/kjae.1999.36.4.653.

Tourniquet Induced Hypertension and Vital Sign Changes in Elderly Patients Associated with Tourniquet Use under General or Epidural Anesthesia for Total Knee Arthroplasty

• Choi Y
• Yang HS
• Park SE
• Kim DY
• Kim HK

• KMID: 2091383
• DOI: http://doi.org/10.4097/kjae.1999.36.4.653

Abstract

BACKGROUND: Tourniquet is associated with tourniquet induced hypertension (T-HTN) and with occasional circulatory collapse. These changes can be well tolerated by young healthy patients; however, in elderly patients with reduced physiologic cardiovascular reserve and blunted baroreflex, these alterations could be significantly detrimental. So we studied that whether there was any difference in hemodynamic changes in elderly patients receiving general or epidural anesthesia.
METHODS
One hundred twenty patients underwent total knee arthroplasty were classified into four groups; general anesthesia in control (<65 years, group I, n=30), general anesthesia in elderly (> or = 65 years, group II, n=30), epidural anesthesia in control (group III, n=30), epidural anesthesia in elderly (group IV, n=30). Mean blood pressure (MAP), heart rate (HR) and PETCO2 were recorded throughout the experiments.
RESULTS
MAP in the general anesthesia was higher than that in the epidural anesthesia after tourniquet inflation and there was pronounced occurrence of T-HTN in the group II (43.3%). After tourniquet deflation, MAP was more reduction in the group II than that in the group IV (23.3+/-10.9% vs 17.4+/-9.4%, p<0.05), and heart rate was increased in all groups except group II. Tourniquet time did not correlate with the magnitude of the changes in MAP and HR associated with tourniquet application.
CONCLUSIONS
In elderly patients associated with general anesthesia, occurrence of "tourniquet hypertension" is more frequent and reduction in MAP after deflation is more marked without compensatory increasing of HR than epidural.

Keyword

Age factor, elderly; Anesthesia techniques, epidural, general; Equipment, pneumatic tourniquet; Surgery, orthopedics, total knee arthroplasty

MeSH Terms

Aged*
Anesthesia, Epidural*
Anesthesia, General
Arthroplasty*
Baroreflex
Blood Pressure
Heart Rate
Hemodynamics
Humans
Hypertension*
Inflation, Economic
Knee*
Shock
Tourniquets*
Vital Signs*