A randomized controlled trial to assess the effect of a ketamine infusion on tourniquet hypertension during general anaesthesia in patients undergoing upper and lower limb surgery

Abstract

Background: Tourniquet hypertension arising from tourniquet inflation remains a primary concern to the anaesthetist. One drug commonly used to manage tourniquet hypertension is ketamine. No studies have examined the effect of ketamine on tourniquet hypertension for a period of more than one hour or an infusion of the same. Objective: To compare the effect of an intravenous infusion of ketamine versus placebo on tourniquet induced hypertension in patients undergoing upper and lower limb surgery under general anaesthesia. Methods: Forty six adult patients scheduled for upper and lower limb surgery under general anaesthesia were randomized into two equal groups. The ketamine group received an intravenous bolus of 0.1mg/kg of ketamine followed by an infusion of 2ug/kg/min. The saline group received an intravenous bolus of physiological saline followed by an infusion of saline. All the patients were reviewed post-operatively. Data of the baseline characteristics, haemodynamic changes, post-tourniquet pain and side effects were collected. If post-tourniquet pain was present post-operatively, a visual analogue scale (VAS) was used to assess its severity. Results: 46 patients successfully completed the trial. There were no significant differences between the groups for baseline patient demographics. The incidence of tourniquet hypertension was higher in the saline group (26.1%) compared with ketamine group (4.6%) with a 95% confidence interval. The difference was shown to be statistically significant ('P'<0.05). There was an increase in systolic blood pressure after 60 minutes of tourniquet inflation in the saline group but the difference was not statistically significant('P'>0.866). There were no significant differences between the groups as regards diastolic blood pressure and heart rate. VAS scores did not differ between the two groups. Statistically, there was no difference found between the two groups. Side effects were minimal in the ketamine group whilst in the saline group, nausea and vomiting were predominant but were also not statistically significant. Conclusion: Based on the results of this study,there was a difference in the proportion of tourniquet hypertension between the ketamine and saline groups for patients undergoing upper and lower limb orthopaedic surgery under general anaesthesia. Keywords: Randomized controlled trial, effect of a ketamine infusion, tourniquet hypertension, general anaesthesia, upper and lower limb surgery.

Advancing pain management for extremity trauma: the evolution of ultrasound-guided nerve blocks for patients in the supine position in trauma centers

“…In cases of extensive lower limb injuries, tourniquets may be applied in the emergency department to reduce bleeding. However, prolonged tourniquet use can cause pain and restlessness in patients, as well as significant hemodynamic fluctuations [60]. Studies have shown that ultrasoundguided iliac fascia plane block or femoral nerve block can effectively alleviate tourniquet-related discomfort [61,62].…”

Effect of Ketamine on Tourniquet Induced Hypertension

“…They reported reduced frequency of hypertension in ketamine group (4.6%) versus the saline group (26%); p-value <0.05. 7 According to literature review, no single technique/medication has been shown to completely prevent tourniquet induced hypertension. Rationale of this study was that currently, at our local institutes, no drug is used for prevention of tourniquet induced hypertension, however, tourniquet induced hypertension is treated with injection Glyceryl trinitrate, increasing the depth of anaesthesia and analgesia.…”

Editorial: Grappling with mother, newborn and child health (MNCH) issues in a continentbeset by non-communicable and infecious diseases

“…Continuing with the theme of surgery in Africa, researchers from Kenya report on the effect of a ketamine infusion on tourniquet hypertension during general anaesthesia in patients undergoing limb surgery 16 ; while Alghadir and others report on the effect of posture on swallowing 17 , with Kamau reporting on the effect of a preanaesthesia clinic consultation on adult patient anxiety at a tertiary hospital in Kenya 18 . Now to pharmacology.…”