Preoperative Small-Dose Ketamine Prevented Tourniquet-Induced Arterial Pressure Increase in Orthopedic Patients Under General Anesthesia

Abstract

The mechanism of tourniquet-induced arterial pressure increase is not known. We investigated the effect of preoperative ketamine on tourniquet-induced arterial pressure and heart rate changes in 85 patients undergoing knee surgery with a tourniquet under general anesthesia. Patients were randomly assigned into three groups; Large Ketamine (n = 28; ketamine 1.0 mg/kg), Small Ketamine (n = 28; ketamine 0.25 mg/kg), and Control (n = 29; normal saline) groups. Anesthesia was maintained with 1.5%-2.5% sevoflurane and 66% N(2)O in oxygen with endotracheal intubation. Ketamine or normal saline was given in a double-blinded fashion before skin incision and tourniquet inflation. Arterial pressure and heart rate were recorded every 10 min until 60 min after the start of tourniquet inflation and again after deflation. Arterial pressure and heart rate were compared among the three groups by using repeated-measures analysis of variance. In the Large and Small Ketamine groups, arterial pressure was not significantly changed, but in the Control group arterial pressure was significantly increased 40, 50, and 60 min after the start of tourniquet inflation (P < 0.05). Development of more than a 30% increase in systolic arterial pressure during tourniquet inflation was more frequent in the Control group than the other groups. The results show that preoperative IV ketamine, 0.25 mg/kg or more, significantly prevented tourniquet-induced systemic arterial pressure increase in patients under general anesthesia. Preoperative small-dose ketamine, IV, significantly prevented a systemic arterial pressure increase during prolonged tourniquet inflation in patients under general anesthesia.