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

Chung,  Wol Son; Kim,  Rak Bum; Park,  Soo Sung; Yang,  Hong Seuk; Suh,  Byung Tae

doi:2000.39.4.462

Clinical Research Article

Korean Journal of Anesthesiology 2000;39(4):462-468.
DOI: https://doi.org/10.4097/kjae.2000.39.4.462

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

Wol Son Chung, Rak Bum Kim, Soo Sung Park, Hong Seuk Yang, Byung Tae Suh

¹Department of Anesthesiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
²Department of Orthopedics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

Abstract

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.

Key Words: Anesthetics, intravenous: enflurane; propofol; volatile; Blood pressure: tourniquet induced hypertension; Equipment: tourniquet