Preoperative Oral Dextromethorphan Attenuated Tourniquet-Induced Arterial Blood Pressure and Heart Rate Increases in Knee Cruciate Ligament Reconstruction Patients Under General Anesthesia

Yamashita, Soichiro; Yamaguchi, Hiroshi; Hisajima, Yu; Ijima, Kazuhiro; Saito, Kaori; Chiba, Ai; Yasunaga, Toru

doi:10.1213/01.ane.0000104610.99716.37

Cited by 16 publications

(11 citation statements)

References 24 publications

(22 reference statements)

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“…16 During lower extremity procedures, different agents such as dextromethorphan, clonidine, remifentanil, and ketamine were used to prevent tourniquet-induced pain. 11,[17][18][19] In a study that compared dextromethorphan and clonidine for blunting the tourniquet-induced cardiovascular response during lower extremity procedures under general anesthesia, it was demonstrated that preoperative oral clonidine significantly decreased systolic, diastolic, and mean arterial pressures. 20 The study of Park et al demonstrated that preoperative low dose ketamine administration (0.1 mg.kg -1 ) is effective in the treatment of tourniquetinduced hypertension for 60 minutes.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

Turhan¹,

Solmaz²,

Vural³

et al. 2015

Turkiye Klinikleri J Anest Reanim

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A AB BS S TTR RA AC CT T O Ob bj je ec ct ti iv ve e: : To investigate the efficacy of calcium channel and beta blockers for controlling tourniquet induced blood pressure increase in patients undergoing carpal tunnel operations with intravenous regional anesthesia (IVRA). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Files of patients who have been operated under IVRA in orthopedics clinics between January 2009 and January 2010 were retrospectively investigated. A total of 312 patients, 164 patients with carpal tunnel syndrome and 148 patients with trigger finger have been operated under IVRA. Out of 164 patients who have been operated due to carpal tunnel syndrome, 50 patients in which either calcium channel blockers or beta blockers were used for treatment of critical blood pressure increase after tourniquet inflation and in which whole data were obtained, were included to the study.The patients with systolic blood pressure above to 150 mmHg following tourniquet inflation and in which bolus dose of calcium channel blocker 10 mg (Group I) or beta blocker 0.5 mg/kg (Group II) have been administered by intravenous route constituted the study groups. The ages of the patients, onset of sensorial block, duration of sensorial block, surgery and tourniquet durations, and the tourniquet pressures were recorded from the patient files. R Re es su ul lt ts s: : There was no difference between groups in terms of demographical variables and hemodynamic parameters (p<0.05). The efficacy of both calcium channel and beta blockers for controlling tourniquet-induced hypertension were similar (p<0.05). C Co on nc cl lu us si io on n: : Although both calcium channel blockers and beta blockers were found to be equally effective in treatment of tourniquet-induced hypertension, there is need of large scale prospective studies in this subject. K Ke ey y W Wo or rd ds s: : Hypertension; carpal tunnel syndrome; anesthesia, conduction Ö ÖZ ZE ET T A Am ma aç ç: : İntravenöz rejyonel anestezi (IVRA) ile karpal tünel operasyonu geçiren hastalarda turnike ile indüklenen kan basıncı artışı üzerine kalsiyum kanal bloker ve beta blokerlerin etkinliğinin araştırılmasıdır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Üniversite Etik Komite onamı alındıktan sonra, Ocak 2009 ve Ocak 2010 tarihleri arasında ortopedi ameliyathanelerinde IVRA ile opere edilen karpal tünel sendromu hastalarının dosyaları retrospektif olarak incelendi. Karpal tünel nedeni ile opere edilen 164 hasta ve tetik parmak nedeni ile opere edilen 148 hasta olmak üzere toplam 312 hasta dosyası incelendi. Karpal tünel nedeni ile opere edilen 164 hasta içinden turnike sonrası kan basıncı artışı tedavisi amacıyla kalsiyum kanal blokeri veya beta bloker kullanılan ve dosya bilgilerine ulaşılan 50 hasta çalışmaya dahil edildi. Turnike şişirilmesi sonrası sistolik kan basıncı 150 mmHg üzerine çıkan ve bolus doz olarak 10 mg kalsiyum kanal blokeri verilen (Grup I) veya 0,5 mg/kg beta bloker (Grup II) verilen hastalar çalışma gruplarını oluşturdu. Hasta dosyaların...

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Section: Discussionmentioning

confidence: 99%

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

Turhan¹,

Solmaz²,

Vural³

et al. 2015

Turkiye Klinikleri J Anest Reanim

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“…On the other hand, the delayed hypertension observed with the use of a tourniquet is known to be related to NMDA receptor activation by peripheral noxious stimuli from the extremities and occurs 40-60 min after inflation 5,6.…”

Section: Discussionmentioning

confidence: 99%

Remifentanil Prevents Tourniquet-Induced Arterial Pressure Increase in Elderly Orthopedic Patients under Sevoflurane/N₂O General Anesthesia

Jung

Han²,

Yi³

et al. 2012

Int. J. Med. Sci.

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Aims: Prolonged tourniquet inflation produces a hyperdynamic cardiovascular response. We investigated the effect of continuous remifentanil infusion on systemic arterial pressure, heart rate, and cardiac output changes during prolonged tourniquet use in elderly patients under sevoflurane/N2O general anesthesia.Methods: Thirty female patients scheduled for knee replacement arthroplasty were infused with either remifentanil at a target organ concentration of 2.0 ng/mL (remifentanil group, n = 15) or saline (control group, n = 15) after induction of anesthesia. Anesthesia was maintained with sevoflurane and N2O. Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), cardiac index (CI), total systemic vascular resistance index (TSVRI), BIS, end-tidal sevoflurane concentration (EtSEVO), and end-tidal carbon dioxide concentration (EtCO2) were measured during the study period.Results: There were significant differences in mean HR, SAP, DAP, and EtSEVO over time between the groups (P = 0.047, P < 0.001, P = 0.017, and P < 0.001, respectively). There was a statistically significant time trend effect (P < 0.001) in HR, SAP, DAP, and CI between the groups, with a statistically significant time-group interaction between the two groups (P = 0.02, 0.007, 0.001, 0.01, respectively).Conclusion: The present study demonstrated that infusion with remifentanil prevented an increase in hemodynamic pressure during tourniquet inflation in elderly patients under sevoflurane/N2O general anesthesia.

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“…The tourniquet induced hypertension (TIH) is usually delayed 30-60 min after tourniquet inflation [5], and it is difficult to treat even with adequate analgesia and good level of anesthesia [6,7]. Although the proper mechanism of (TIH) is still unclear [7], the autonomic nervous system is probably involved and plasma catecholamine levels are increased [2].…”

Section: Introductionmentioning

confidence: 99%

“…Also, stimulation of N-methyl-D-Aspartate (NMDA) receptors by noxious stimuli from the extremities is another possible cause leading to TIH [8,9]. There are several studies done using different analgesics and NMDA receptor antagonists to find an effective drug to attenuate (TIH) [6][7][8]5].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative lidocaine infusion attenuates tourniquet induced hypertension in patients undergoing anterior cruciate ligament reconstruction under general anesthesia

ElSayed

Hasanein

2016

Egyptian Journal of Anaesthesia

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Objective: This randomized, double blind, controlled study was designed to test whether the intraoperative use of intravenous lidocaine bolus followed by infusion would attenuate the tourniquet induced hypertension (TIH) in patients undergoing anterior cruciate ligament reconstruction (ACLR) under general anesthesia. Methods: 76 patients were randomly allocated into two equal groups. Lidocaine group (group L), in which patients received lidocaine 2% 1 mg/kg IV bolus after induction of anesthesia followed by lidocaine infusion (2 mg/kg/h) and placebo group (group P), in which patients received equal volumes of saline. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded before induction of anesthesia, before tourniquet inflation (baseline value), every 15 min after tourniquet inflation, and after tourniquet deflation. The number of patients who developed TIH was recorded and total amount of propofol and fentanyl used intraoperative was recorded. Results: SBP, DBP and HR were significantly less after tourniquet inflation in group L compared to group P in most of the time periods after tourniquet inflation (p value < 0.05), the number of patients developed TIH was significantly less in group L compared to group P (26% in group L compared to 52.6% in group P) (p value 0.019), and the total amount of propofol and fentanyl used intraoperative was significantly less in group L compared to group P (p value 0.000). Conclusion: Intraoperative use of lidocaine bolus (1 mg/kg), followed by infusion (2 mg/kg/h), started 10 min before tourniquet inflation attenuated the TIH in patients undergoing anterior cruciate ligament reconstruction under general anesthesia.

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Preoperative Oral Dextromethorphan Attenuated Tourniquet-Induced Arterial Blood Pressure and Heart Rate Increases in Knee Cruciate Ligament Reconstruction Patients Under General Anesthesia

Abstract: We demonstrated that preoperative oral dextromethorphan 30 mg significantly attenuated arterial blood pressure and heart rate increases at 60 min during tourniquet inflation in patients undergoing knee cruciate ligament reconstruction under general anesthesia.

Cited by 16 publications

References 24 publications

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

Remifentanil Prevents Tourniquet-Induced Arterial Pressure Increase in Elderly Orthopedic Patients under Sevoflurane/N₂O General Anesthesia

Intraoperative lidocaine infusion attenuates tourniquet induced hypertension in patients undergoing anterior cruciate ligament reconstruction under general anesthesia

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Preoperative Oral Dextromethorphan Attenuated Tourniquet-Induced Arterial Blood Pressure and Heart Rate Increases in Knee Cruciate Ligament Reconstruction Patients Under General Anesthesia

Abstract: We demonstrated that preoperative oral dextromethorphan 30 mg significantly attenuated arterial blood pressure and heart rate increases at 60 min during tourniquet inflation in patients undergoing knee cruciate ligament reconstruction under general anesthesia.

Cited by 16 publications

References 24 publications

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

Comparison of Effects of Calcium Channel Blockers and Beta Blockers on Tourniquet-Induced Hypertension During Intravenous Regional Anesthesia

Remifentanil Prevents Tourniquet-Induced Arterial Pressure Increase in Elderly Orthopedic Patients under Sevoflurane/N2O General Anesthesia

Intraoperative lidocaine infusion attenuates tourniquet induced hypertension in patients undergoing anterior cruciate ligament reconstruction under general anesthesia

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Remifentanil Prevents Tourniquet-Induced Arterial Pressure Increase in Elderly Orthopedic Patients under Sevoflurane/N₂O General Anesthesia