Tourniquet Induced Hypertension and Vital Sign Changes in Patients with Total Knee Replacement Arthroplasty under General Anesthesia with Enflurane or Propofol / 대한마취과학회지

BACKGROUND: The tourniquet is associated with severe hemodynamic changes and tourniquet-induced hypertension (T-HTN). Propofol is preferred as an anesthetic agent for rapid induction and recovery, and less nausea and vomiting. The aim of this study was to find the difference in hemodynamic changes and the T-HTN in patients with total knee replacement arthroplasty receiving enflurane or propofol anesthesia. METHODS: One hundred patients underwent total knee replacement arthroplasty were divided into four groups; enflurane-control (n = 22), enflurane-elderly (n = 28), propofol-control (n = 22), propofol-elderly (n = 28). Mean arterial blood pressure (MAP), heart rate (HR) and end-tidal CO2 (PETCO2) were recorded throughout the operations of each group. Statistical analysis was done using repeated measures of ANOVA, chi-square test (P < 0.05). RESULTS: MAP increased in the propofol group during the tourniquet inflation period compared to the period before tourniquet inflation. The incidence of T-HTN in the propofol group (58%) was higher than that of the enflurane group (36%). HR increased in the enflurane group just after tourniquet inflation. PETCO2 decreased during 20 60 minutes after tourniquet inflation in the propofol group (P < 0.05). MAP decreased and PETCO2 increased during the 1, 5 minutes after tourniquet deflation in all groups. There were minimal HR changes after tourniquet deflation in all groups. CONCLUSIONS: T-HTN occurrence and MAP were shown to be higher in the propofol anesthesia and both enflurane and propofol can be used as an anesthetic agent for total knee replacement arthroplasty without complications.

Cardiopulmonary Bypass in Patient with Heparin-Induced Thrombocytopenia Employing Recombinant Hirudin / 대한마취과학회지

Heparin-induced thrombocytopenia (HIT) is a heparin-dependent antibody-mediated platelet activating syndrome frequently accompanying thrombocytopenia, thromboembolism. We experienced a case of cardiopulmonary bypass using hirudin, a direct thrombin inhibitor, in a patient with HIT. The patient who showed thrombocytopenia and thrombosis after heparin re-exposure was highly suspected of having HIT. Hirudin was used in this case as an anticoagulating agent during cardiopulmonary bypass (CPB) to prevent serious complications of heparin. Hirudin 0.3 mg/kg was mixed with a priming solution of CPB and a 0.2 mg/kg IV bolus followed by a continuous infusion of hirudin 0.15 mg/kg given for anticoagulation. After CPB, forced diuresis and platelet transfusion was performed and the patient was recovered without complication.