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

Abstract

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.

Tourniquet application during anesthesia: “What we need to know?”

“…These changes persist until tourniquet deflation and poorly respond to analgesic drugs or increasing the depth of anesthesia. Many interventions have been reported to reduce cardiovascular stress:[242526272829303132] Ketamine, dexmedetomidine, magnesium sulfate, clonidine, and remifentanil infusion.…”

“…Many techniques[27] like application of EMLA cream, infiltration with local anesthetics, use of wider cuff with lower inflation pressure, addition of opioids, clonidine, epinephrine along with local anesthetics in spinal block have been tried in order to decrease the incidence or severity of this pain but none has attained complete success in pain relief. Intravenous drugs,[242527282930313247] ketamine, dexmedetomidine, magnesium sulfate, clonidine remifentanil infusions have also been studied, and the only thing that works reliably is tourniquet deflation.…”

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

“…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.…”

Is Remifentanil Superior to Nitrous Oxide Regarding the Clinical Effects?

“…Fakat, hipotansiyon, PBK, solunum depresyonu ve artmış postoperatif ağrı gibi yan etkilere sahiptir. Ayrıca, hızlı etki başlangıcı apne ve kas rijiditesi gibi yan etkilere de neden olabilir (11) . (12) .…”