Hemodynamic and Arterial Blood Gas Changes following Tourniquet Use under General Anesthesia with Sevoflurane or Propofol for Total Knee Replacement (TKR) in Geriatric Patients

ABSTRACT

BACKGROUND: Tourniquets are widely used to provide a clean surgical field but can induce variable hemodynamic and metabolic changes. Sevoflurane is one of anesthetic agents used for unstable or elderly patients, and propofol can be used for smooth induction and early recovery with few side effects. This study evaluated the differences in the hemodynamic and metabolic changes after the application of a tourniquet under general anesthesia with sevoflurane or propofol for total knee replacement (TKR). METHODS: Thirty elderly female patients scheduled to undergo TKR were allocated into two groups, the general anesthesia with sevoflurane group (S group, n = 15) or the propofol group (P group, n = 15). The hemodynamic parameters such as the mean arterial pressure (MAP), heart rate (HR), central venous pressure (CVP), cardiac index (CI), stroke volume (SV), systemic vascular resistance (SVR), and arterial blood analysis were checked immediately before (control, T1), at 5 (T2), 30 (T3) and 60 minute (T4) after inflation, and at 5 (T5) and 30 minutes after (T6) deflation. RESULTS: Compared with T1, the MAP increased significantly at T2, T3, and T4 in both groups. The increase in the SVR after inflating the tourniquet and the decrease in the SVR after deflation were lower in the P group than in the S group. The metabolic changes after deflating the tourniquet were similar in both groups. CONCLUSIONS: Compared with sevoflurane, propofol did not significantly decrease the hemodynamic and metabolic changes after placing a tourniquet during TKR for elderly patients. therefore, both sevoflurane and propofol are acceptable anesthetics for TKR in geriatric patients.