Effect of hydroxyethyl starch 130/0.4 on ischemia-reperfusion determinants in minor lower extremity surgery with tourniquet application

• Published in: Journal of clinical anesthesia 2015-03, Vol.27 (2), p.105-110
• Main Authors: Pinar, Hüseyin Ulaş, MD, Pinar, Aşina, MD, Mavioğlu, Ömür, MD, Yener, Nilgün
• Format: Article
• Language: English
• Subjects: Adult; Anesthesia; Anesthesia & Perioperative Care; Anesthesia, Spinal - methods; Arthroscopy; Blood pressure; Bone surgery; Female; Humans; Hydroxyethyl starch; Hydroxyethyl Starch Derivatives - therapeutic use; Hypoxanthine - blood; Ischemia; Ischemia-reperfusion injury; Knee; Knee Joint - surgery; Lipid peroxidation; Lower Extremity - surgery; Male; Malondialdehyde - blood; Middle Aged; Orthopedic Procedures - methods; Pain Medicine; Patients; Permeability; Plasma Substitutes - therapeutic use; Prospective Studies; Reperfusion Injury - blood; Reperfusion Injury - etiology; Reperfusion Injury - prevention & control; Rodents; Tourniquet; Tourniquets - adverse effects; Xanthine Oxidase - blood; Young Adult
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2014.07.001

Abstract Study Objective To investigate the effect of 6% hydroxyethyl starch (HES) (130/0.4) infusion on ischemia-reperfusion determinants in minor lower extremity operations with tourniquet application. Design Prospective, randomized, clinical trial. Setting University hospital operation room. Patients American Society of Anesthesiologists I and II 40 patients between 18 and 65 years of age who were scheduled to undergo knee arthroscopy and below-knee minor orthopedic surgery. Interventions Patients were randomized into 2 groups (normal saline [NS] group and HES group). Unilateral spinal anesthesia with 2-mL 0.5% hyperbaric bupivacaine after 10 mL/kg NS intravenous infusion to NS group and 10 mL/kg 6% HES intravenous infusions to HES group. Main Outcome Measures Blood samples were obtained from antecubital vein for malondialdehyde, xanthine oxidase, and hypoxanthine before tourniquet inflation and after 10 minutes of tourniquet deflation. Results There was no significant difference between groups with respect of hemodynamic data. There were no significant differences between 2 groups in terms of malondialdehyde values before tourniquet inflation and after tourniquet deflation. In the HES group, xanthine oxidase levels after tourniquet deflation were significantly lower than xanthine oxidase levels before tourniquet inflation ( P < .05). In the HES group, hypoxanthine levels after tourniquet deflation were similar with the basal levels; however, they were significantly higher than levels obtained before tourniquet inflation in the SF group ( P < .05). Conclusion HES infusion may be beneficial for reduction of tourniquet-associated ischemia-reperfusion injury; however, further large-scale studies are needed to fully elucidate its mechanism.