The effects of spinal, inhalation, and total intravenous anesthetic techniques on ischemia-reperfusion injury in arthroscopic knee surgery

Abstract

Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t 1), 30 min after tourniquet inflation (t 2), immediately before (t 3), and 5 min (t 4), 15 min (t 5), 30 min (t 6), 1 h (t 7), 2 h (t 8), and 6 h (t 9) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t 2 - t 9 and t 2 - t 7. MDA levels in Group T and Group I were significantly lower than those in Group S at t 2 - t 8 and t 2 - t 9. IMA levels in Group T were significantly lower than those in Group S at t 2 - t 7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion. © 2014 Müge Koşucu et al.