Aldemir O, Celebi H, Cevik C, Duzgun E
Department of Anaesthesiology, Gazi University, School of Medicine, Ankara, Turkey.
Acta Anaesthesiol Scand. 2001 Nov;45(10):1221-5. doi: 10.1034/j.1399-6576.2001.451008.x.
Ischaemia-reperfusion injury following tourniquet release is a good in vivo model for evaluating acute conditions. The aim of the study was to investigate the effects of propofol or halothane anaesthesia on oxidative stress by determining malondialdehyde (MDA) levels during knee arthroplasty.
Thirty patients undergoing orthopaedic surgery were divided into two groups. Anaesthesia was induced with either fentanyl 100 microg and propofol 2 mg kg(-1) (Group 1) or fentanyl 100 microg and thiopentone 5 mg kg(-1) (Group 2) and maintained with infusion of propofol in Group 1 or inhalation of halothane in Group 2. ECG, SpO2, EtCO2, and mean arterial pressure (MAP) were monitored. Venous and arterial blood samples were obtained at different measurement times for MDA and blood gas analyses.
There was a significant decrease in MAP in the 1st and 5th minutes after tourniquet release (ATR) when compared with the 5th minute before tourniquet release (BTR) in both groups. Heart rate (HR) increased significantly in the 1st minute ATR in Group 1 only. EtCO2 increased significantly in the 1st and 5th minutes ATR, SpO2 decreased in the 1st minute ATR in both groups. There was a significant decrease in pH and increase in pCO2 at 1, 5 and 30 min ATR in both groups. pO2 values decreased in the 1st minute ATR in Group 1 only and returned to control values at 5 min ATR and decreased at 30 min ATR in the recovery room in both groups. The differences in SaO2 were similar to SpO2. MDA levels decreased before and after release of tourniquet when compared to baseline in both groups. However, there was a statistically significant decrease only in Group 1.
Propofol may be a good choice of anaesthetic when an ischaemia-reperfusion injury is anticipated as in orthopaedic surgery requiring a tourniquet, due to its antioxidant properties, but halothane needs further study.
止血带松开后的缺血再灌注损伤是评估急性病症的良好体内模型。本研究的目的是通过测定膝关节置换术中丙二醛（MDA）水平，研究丙泊酚或氟烷麻醉对氧化应激的影响。
30例接受骨科手术的患者分为两组。一组用100微克芬太尼和2毫克/千克丙泊酚诱导麻醉（第1组），另一组用100微克芬太尼和5毫克/千克硫喷妥钠诱导麻醉（第2组），第1组用丙泊酚持续输注维持麻醉，第2组用氟烷吸入维持麻醉。监测心电图、脉搏血氧饱和度（SpO2）、呼气末二氧化碳分压（EtCO2）和平均动脉压（MAP）。在不同测量时间采集静脉血和动脉血样本，用于MDA和血气分析。
与止血带松开前5分钟（BTR）相比，两组止血带松开后（ATR）第1分钟和第5分钟MAP均显著下降。仅第1组在ATR第1分钟心率（HR）显著增加。两组在ATR第1分钟和第5分钟EtCO2显著增加，两组在ATR第1分钟SpO2均下降。两组在ATR第1、5和30分钟pH显著下降，pCO2升高。仅第1组在ATR第1分钟pO2值下降，在ATR第5分钟恢复至对照值，两组在恢复室ATR第30分钟pO2值下降。血氧饱和度（SaO2）的差异与SpO2相似。与基线相比，两组止血带松开前后MDA水平均下降。然而，只有第1组有统计学意义的下降。
由于丙泊酚具有抗氧化特性，在预计会发生缺血再灌注损伤的骨科手术（如需要使用止血带的手术）中，丙泊酚可能是一种良好的麻醉选择，但氟烷还需要进一步研究。
