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

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.