Hakan ÖZDEMİR, Nursel ŞAHİN, Karakaya Hanife KABUKÇU, Tülin Aydoğan TİTİZ

Diz artroskopisinde spinal anestezi altında turnike uygulanmasının hemodinamik ve metabolik etkileri

Bu çalışmada; spinal anestezi altında, tek taraflı diz artroskopisi uygulanacak olgularda, alt ekstremitede uyluk üzerinden turnike uygulanmasının oluşturduğu hemodinamik ve metabolik değişiklikler ile doku hasan araştırıldı. Lateral pozisyonda 22 C spinal iğne ile 1.3.4 aralığından 3 mi %0.5 bupivakain heavy verilerek spinal anestezi sağlanan 15 hastada sistolik, diyastolik arter basıncında ve kalp atım hızında turnike uygulanması ve açılmasından sonra istatistiksel olarak anlamlı düşüş saptandı. Turnike açılması ile S.dk'da arteryel pH, PaCC>2 ve HCOf düştü ve Pa-O2 ve K+ düzeyi yükseldi. Spinal anestezi ile, alt ekstremite cerrahisi sırasında tek taraflı turnike uygulanan olgularda klinik olarak önemli hemodinamik ve metabolik değişiklikler ile ciddi doku hasarı saptanmamıştır.

Hemodynamic and metabolic effects of tourniquet application in knee arthroscopy under spinal anaesthesia

In this study, we investigated the hemodynamic, and metabolic changes and tissue damages occured after the appliment of tourniquet on thight in patients who have undergone lower extremity knee arthroscopy under spinal anaesthesia. Spinal anesthesia was performed to 15 patients in lateral position giving 3 ml 0.5% bupivacaine heavy by the use of 22G spinal needle from 13-4 interspace. Systolic and diastolic blood pressure and heart rate were decreased during and after tourniquet application. With tourniquet deflation in 5. minutes arterial pH, PaCC>2 and HCOf were decreased and PaC>2 and K+ level were increased. We conclude that with using spinal anaesthesia, significant hemodynamic and metabolic changes and tissue damage were not observed during unilateral tourniquet application in arthroscopic surgery.

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1. Kaufman RD, Walts LF.Tourniquet–induced hypertension. Br J Anaesth 1982;54:333–36. 2. Valli H, Rosenberg PH, Kytta J, Nurminen M. Arterial hypertension associated with the use of tourniquet with either general or regional anesthesia: Acta Anaesthesiol Scand 1987; 31:279–83. 3. Richard LD, Brian WZ. The effect of tourniquets on muscle enzymes during foot and ankle surgery. J Food Ankle Surg 1993;32:280–85. 4. Girardis M, Milesi S, Donato S, et al. The hemodynamic and metabolic effects of tourniquet aplication during knee surgery. Anesth Analg 2000; 91:727- 31. 5. Valli H, Rosenberg PH. Effects of three anesthesia methods on haemodynamic responses connected with the use of thigh tourniquet in orthopaedic patient. Acta Anaesthesiol Scand 1985; 29:142-47. 6. Modig J, Kolstad Kwigren A. Sistemic reactions to tourniquet ischaemia. Acta Anaesthesiol Scand 1978;22:609-14. 7. Townsend HS, Goodman SB, Schurman DJ, et al. Tourniquet release: systemic and metabolic effects. Acta Anaesthesiol Scand 1996;40:1234-37. 8. Brutowicz RM, Moncorge C, Koka BV. Metabolic responses to tourniquet release in childeren. Anesthesiology 1987; 67:792-94 9. Szasz G, Busch EW, Farohs HB. Metodische erfahrungen und normalwerte mit einem neuen handelsüblichen. Test Dtsch.med.Wschr.1970; 95: 829-33. 10. Pedowitz RA, Gershuni DH, Friden J, et al. Effects of reperfusion intervals on muscle injury beneath and distal to a pneumatic tourniquet. J Hand Surg 1992;17:245-55. 11. Jacobson MD, Pedowitz RA, Oyama BK, et al. Muscle functional deficits after tourniquet ischemia. Am J Sports Med 1994; 22:372-73.