Abstract
Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced and maintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t 1), 30 min after tourniquet inflation (t 2), immediately before (t 3), and 5 min (t 4), 15 min (t 5), 30 min (t 6), 1 h (t 7), 2 h (t 8), and 6 h (t 9) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t 2–t 9 and t 2–t 7. MDA levels in Group T and Group I were significantly lower than those in Group S at t 2–t 8 and t 2–t 9. IMA levels in Group T were significantly lower than those in Group S at t 2–t 7. Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.
Highlights
A proximal tourniquet is often used in lower limb surgery to provide a bloodless operative field
Cell injury caused by oxidative stress involves lipids, protein, and DNA, is caused by oxidative stress, and leads to the production of toxic metabolites such as malondialdehyde (MDA) and ischemia-modified albumin (IMA) [1]
Prospective study, our aim was to evaluate the effect of different anesthetic techniques—total intravenous anesthesia (TIVA) with propofol, inhalation anesthesia with sevoflurane, and spinal anesthesia with levobupivacaine— on tourniquet-related ischemia-reperfusion by determining MDA and IMA levels and side effects in the context of arthroscopic ACL reconstruction surgery
Summary
A proximal tourniquet is often used in lower limb surgery to provide a bloodless operative field. Cell injury caused by oxidative stress involves lipids, protein, and DNA, is caused by oxidative stress, and leads to the production of toxic metabolites such as malondialdehyde (MDA) and ischemia-modified albumin (IMA) [1]. Its levels rise as an indicator of lipid peroxidation, and it has often been used as a marker of free radical formation [1,2,3, 5, 6]. There are many studies [7,8,9,10,11] concerning the rise in IMA levels in acute ischemic conditions, such as myocardial, pulmonary, cerebral, mesenteric, and skeletal muscle ischemia or infarct
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