Korean J Anesthesiol.  2008 Oct;55(4):412-418. 10.4097/kjae.2008.55.4.412.

Hemodynamic comparison of propofol-remifentanil and sevoflurane based anesthesia for total knee arthroplasty using tourniquet

• Sohn JE
• Kim YJ
• Baik HJ
• Kim JH

• KMID: 2237400
• DOI: http://doi.org/10.4097/kjae.2008.55.4.412

Abstract

BACKGROUND
Use of pneumatic tourniquet is commonly accepted in total knee arthroplasty (TKA) to reduce perioperative blood loss. However, hemodynamic changes and cardiovascular collapse, which is caused by tourniquet, might be fatal to elderly patient. It is important to maintain the hemodynamic stability. We evaluated the effect of general anesthesia using propofol-remifentanil or sevoflurane on hemodynamic changes by using tourniquet during TKA.
METHODS
Thirty patients underwent TKA were randomly divided into two groups; propofol-remifentanil (n = 15) and sevoflurane (n = 15). Mean arterial blood pressure (MBP), heart rate (HR), central venous pressure (CVP), stroke volume (SV), cardiac index (CI) and systemic vascular resistance (SVR) were recorded throughout the operation. Statistical analysis was done using nonparametric test and repeated measures of ANOVA.
RESULTS
There are no differences in MBP, HR, CVP and SV between both groups during the tourniquet inflation but there are differences of CI at the 6, 9, 12 minute after the tourniquet inflation. During the tourniquet deflation, there are differences of MBP, HR between the two groups at just after, 3, 30, 45 minutes after the tourniquet deflation. But the changes of both groups are within 20% of baseline. There are no differences of CVP, SVR between the two groups during the tourniquet deflation.
CONCLUSIONS
Propofol-remifentanil based anesthesia provided more stable hemodynamic conditions than sevoflurane based anesthesia, although both may be useful techniques for maintaining the hemodynamic changes within 20% of the baseline values, according to the tourniquet application in TKA.

Keyword

elderly patient; propofol; sevoflurane; total knee arthroplasty; tourniquet

MeSH Terms

Aged
Anesthesia
Anesthesia, General
Arterial Pressure
Arthroplasty
Central Venous Pressure
Heart Rate
Hemodynamics
Humans
Inflation, Economic
Knee
Methyl Ethers
Propofol
Stroke Volume
Tourniquets
Vascular Resistance
Methyl Ethers
Propofol