Dexmedetomidine did not reduce the effects of tourniquet-induced ischemia-reperfusion injury during general anesthesia (original) (raw)
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International Journal of Anesthetics and Anesthesiology, 2015
Background: This study aims to compare the impact of sedation, continuous dexmedetomidine and propofol infusion, to oxidative stress that occurred as a result of tourniquet-induced ischemia reperfusion (IR) during lower extremity surgery. Material & Methods: All patients were administered combined spinoepidural anesthesia; Group D received infusion of 1µg kgdexmedetomidine for 10 minutes and 0.5µg kghinfusion, Group P was administered 0.2 mg kgpropofol following bolus 2 mg kgmin-. At baseline, 20 minutes and two hours after the tourniquet was released, plasma total antioxidant status (TAS), total oxidant status (TOS), paraoxonase (PON), stimulated paraoxonase (SPON), arylesterase, ceruloplasmin, myeloperoxidase (MPO), ischemia modified albumin (IMA) and advanced oxidation protein products (AOPP) levels were analyzed. Results: In Group D, ceruloplasmin values taken post tourniquet release were lower compared to the baseline values (p = 0.02 and 0.008, respectively). As for Group P, a decrease in the TAS and TOS values was recorded two hours after the tourniquets were released (in both p = 0.008). No differences were found in other markers of oxidative stress during intra-group comparisons (p > 0.05). Conclusion: The study concluded that administration of propofol and dexmedetomidine sedation during lower extremity surgery had similar effects on oxidative stress caused by tourniquet-induced IR.
Vojnosanitetski Pregled, 2010
Background/Aim. Reperfusion of previously ischemic tissue leads to injuries mediated by reactive oxygen species. The aim of the study was to investigate the effects of different anesthesia techniques on oxidative stress caused by tourniquetinduced ischemia-reperfusion (IR) injury during extremity operations at children's age. Methods. The study included 45 patients American Society of Anesthesiologists (ASA) classification I or II, 8 to 17 years of age, undergoing orthopedic procedures that required bloodless limb surgery. The children were randomized into three groups of 15 patients each: general inhalational anesthesia with sevoflurane (group S), total intravenous anesthesia with propofol (group T) and regional anesthesia (group R). Venous blood samples were obtained at four time points: before peripheral nerve block and induction of general anesthesia (baseline), 1 min before tourniquet release (BTR), 5 and 20 min after tourniquet release (ATR). Postischemic reperfusion injury was estimated by measurement of concentration of malondialdehyde (MDA) in plasma and erythrocytes as well as catalase (CAT) activity. Results. Plasma MDA concentration in the group S was significantly higher at 20 min ATR in comparison with the groups T and R (6.78 ± 0.33 µmolL-1-1 vs 4.07 ± 1.53 and 3.22 ± 0.9. µmolL-1-1 , respectively). There was a significant difference in MDA concentration in erytrocythes between the groups S and T after 5 min of reperfusion (5.88 ± 0.88 vs 4.27 ± 1.04 nmol/mlEr, p < 0.05). Although not statistically significant, CAT activity was slightly increased as compared to baseline in both groups S and R. In the group T, CAT activity decreased at all time points when compared with baseline, but the observed decrease was only statistically significant at BTR (34.70 ± 9.27 vs 39.69 ± 12.91 UL-1, p < 0.05). Conclusion. Continuous propofol infusion and regional anesthesia techniques attenuate lipid peroxidation and IR injury connected with tourniquet application in pediatric extremity surgery.
Purpose: Ischemia-reperfusion injury is one of the consequences of tourniquet application for extremity surgery. The aim of the study was to establish the effect of dexmedetomidine on the acute lung injury following lower extremity experimental ischemia-reperfusion model in rats. Methods: Twenty-eight Wistar-Albino breed Rats were recruited after Ethics Committee approval and allocated into 4 groups, each with 7 subjects. Group 1 (SHAM) received only anesthesia. Group 2 (IR) had experienced 3 h of ischemia and 3 h of reperfusion using left lower extremity tourniquet after anesthesia application. Groups 3 (D-50) and 4 (D-100) had undergone the same procedures as in the Group 2, except for receiving 50 and 100 mg·kg −1 , respectively, dexmedetomidine intraperitoneally 1 h before the tourniquet release. Blood samples were obtained for the analysis of tumor necrosing factor-and interleukin-6. Pulmonary tissue samples were obtained for histological analysis. Results: No significant difference regarding blood tumor necrosing factor-and interleukin-6 values was found among the groups, whereas pulmonary tissue injury scores revealed significant difference. Histological scores obtained from the Group 2 were significantly higher from those in the Groups 1, 3 and 4 with p-values 0.001 for each comparison. Moreover, Group 1 scores were found to be significantly lower than those in the Groups 3 and 4 with p-values 0.001 and 0.011, respectively. No significant difference was observed between the Groups 3 and 4. Conclusion: Dexmedetomidine is effective in reduction of the experimental ischemia-reperfusion induced pulmonary tissue injury in rats, formed by extremity tourniquet application .
An Evaluation of the Effects of Perioperatively Administered Fluids on Ischemia/Reperfusion Injury
Pakistan Journal of Medical Sciences, 1969
Objective: To investigate the effects of normal saline (0.9% NaCl) and 6% Hydroxyethyl Starch 130/0.4(HES) solution on Ischemia/Reperfusion (I/R) injury in patients undergoing knee arthroscopy operations with spinal anesthesia using a tourniquet. Methods: The study comprised 48 ASA I-II patients undergoing knee arthroscopy with spinal anesthesia using a tourniquet. The patients were randomised into two groups and after standard monitoring two venous lines were introduced to obtain blood samples and to give intravenous therapy. In the control group (Group A) (n=21) 0.9% NaCl, 10 ml/kg/hours and in the study group (Group B) (n=19) 6% Hydroxyethyl Starch 130/0.4, 10 ml/kg/hours infusion were administered. Spinal anesthesia was applied with 12.5 mg hyperbaric bupivacaine to all patients. The tourniquet was applied and the operation was started when the sensorial block level reached T10 dermatome. Blood xanthine oxidase (XO) and malondialdehyde (MDA) levels as an indicator of ischemia and reperfusion injury were measured in samples before fluid infusion (t1), before tourniquet application (t2), 1 minute before tourniquet release (t3), and at 5 (t4) and 15 (t5) minutes after tourniquet release. Results: No difference was observed between the two groups in respect of demographic parameters, the highest block level, duration before tourniquet application and tourniquet duration (p>0.05). The MDA level after tourniquet application and 15 minutes after tourniquet release was lower in Group B (p<0.05). XO levels were not different (p>0.05). Conclusion: In this study 6% Hydroxyethyl Starch 130/0.4 solution reduced MDA level which is an indicator of lipid peroxidation. 6% Hydroxyethyl Starch 130/0.4 solution may be beneficial for Ischemia/reperfusion injuries.
Annals of International medical and Dental Research, 2016
Background: Pneumatic Tourniquets are commonly used in orthopaedic surgery of the extremities to reduce bleeding and to provide a clear field to the surgeon, but severe pain often complicates the tourniquet inflation. Although the mechanism of tourniquet induced hypertension (TIH)is not well understood, the autonomic nervous system plays an important role. Hence, Dexmedetomidine, a potent a2-adrenoceptor agonist may prevent hyper adrenergic responses and can be of prophylactic value for tourniquet induced hypertension. Methods: Forty American Society of Anesthesiologists (ASA) physical status class I and II children, aged 5-12 years, posted for Orthopaedic surgery of upper limbs under general anaesthesia with tourniquet application were included in the study. They were randomly assigned to receive intravenous Dexmedetomidine (Group D; n=20) or normal saline (Group C; n=20) before tourniquet inflation. Incidence of TIH, Mean Arterial blood pressure and heart rate were recorded. Results: There were no significant differences between the baseline characteristics. The incidence of TIH in group D was significantly less than the group C (20%) as compared to group D (70%).There was significant increase in the heart rate of placebo group after 30 minutes of tourniquet inflation while there was minimal variability of heart rate in the group D. In the group D, arterial pressure was not significantly changed, but in the group C, the arterial pressure was significantly increased after 20 minutes of tourniquet inflation. No significant adverse effects were noted in any group. Conclusion: Preoperative low dose intravenous Dexmedetomidine prevents tourniquetinduced hypertension in paediatric patients undergoing general anaesthesia for upper limb surgeries.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University
Following ischemia/reperfusion injury, antioxidant defense mechanisms may remain insufficient depending on the duration of ischemia which is caused by any reason (MI, after percutaneous coronary intervention, during cardiac surgery). After that, free oxygen radicals increasing within the cell cause structural deterioration. Cytokines which activate a series of reactions that cause tissue damage and inflammatory response are released during reperfusion of ischemic tissues. In this study, we aimed to compare the effects of dexmedetomidine and ketamine in cardiac ischemia/reperfusion injury. The study included 18 rats randomly divided into three groups. Group I/R (n = 6): control, Group I/R-K (n = 6): ketamine, and Group I/R-D (n = 6): dexmedetomidine. Before the 10 min surgery, after the 20 min ischemia and 20 min reperfusion period, hemodynamic parameters were compared among the three groups. After the 45 min ischemia and 120 min reperfusion period, tissue samples were obtained from ...
Dexmedetomidine for sedation in the medical ICU
Critical Care, 2000
The incidence of PMI among patients undergoing noncardiac surgery is low and its mortality is negligible. Physicians should become more selective in the use of monitored beds and in the ordering of a work up to rule out PMI.