Abstract
Ischemia and reperfusion injury due to tourniquet application during arthroscopy is a well known problem. This study aimed to compare the effects of dexmedetomidine and ketamine on hemodynamic and respiratory variables and on total anti-oxidant status (TAS), total oxidant status (TOS) and malondialdehyde (MDA) as markers of ischemia-reperfusion injury. This study was approved by a local ethics committee. The study was performed on patients undergoing arthroscopic operation under spinal anesthesia. Thirty patients were randomized into two groups: Group D (dexmedetomidine; n=15) and Group K (Ketamine; n=15). Spinal anesthesia at the L2-4 level was achieved using a 25G spinal needle with hyperbaric bupivacaine at a dose of 12-15 mg in all patients. In Group D, patients were sedated with dexmedetomidine at a dose of 0.3-0.5 μg/kg/h, while Group K received ketamine at a dose of 1-1.5 mg/kg/h. Hemodynamic parameters, oxygen saturation, Ramsey sedation scale (RSS), and TAS, TOS, and MDA levels were recorded. Demographic parameters, TAS, TOS and MDA levels were similar between groups. In Group K, the TOS levels after tourniquet removal were significantly lower than at baseline and during the use of the tourniquet. Preoperative hemodynamic and respiratory variables were similar in both groups. Blood pressure values were decreased compared to baseline but these decreases were not statistically significant. In patients undergoing arthroscopy under spinal anesthesia, dexmedetomidine had effects similar to ketamine, led to insignificant alterations in hemodynamic and respiratory variables during surgery and had comparable effects on ischemia-reperfusion injury. Thus, we think that dexmedetomidine can be a safe alternative to ketamine as an intraoperative sedative.
Highlights
Surgery of the extremities can be performed under tourniquet control to provide a bloodless field, but this technique causes one of the most common forms of skeletal muscle ischemia-reperfusion (I/R) injury
In patients undergoing arthroscopy under spinal anesthesia, dexmedetomidine had effects similar to ketamine, led to insignificant alterations in hemodynamic and respiratory variables during surgery and had comparable effects on ischemia-reperfusion injury
We think that dexmedetomidine can be a safe alternative to ketamine as an intraoperative sedative
Summary
Surgery of the extremities can be performed under tourniquet control to provide a bloodless field, but this technique causes one of the most common forms of skeletal muscle ischemia-reperfusion (I/R) injury. Prolonged ischemia with tourniquet inflation and subsequent reperfusion causes lipid peroxidation, resulting in tissue injury [1]. Lipid peroxidation in the cellular membrane, which is caused by free oxygen radicals (FOR) occurring during I/R, leads to MDA release, which indicates the degree of oxidative stress and tissue injury [2]. Oxidative stress can be defined as an imbalance between oxidants and antioxidants. Excess oxidants and/or a depletion of antioxidants in the organism cause oxidative stress. Plasma total antioxidant status (TAS) level is another well-established marker of oxidative stress, indicating the anti-oxidant defense status of the organism [3]
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