Ketamine Sedation During Spinal Anesthesia for Arthroscopic Knee Surgery Reduced the Ischemia-Reperfusion Injury Markers

Abstract

We studied the effect of ketamine sedation on oxidative stress during arthroscopic knee surgery with tourniquet application by determining blood and tissue malonyldialdehyde (MDA) and hypoxanthine (HPX) levels. Thirty ASA I-II patients undergoing arthroscopic knee surgery with tourniquet were randomly divided into two groups. Spinal anesthesia induced with 12.5 mg bupivacaine was administered to all patients. In the ketamine group, after IV administration of 0.01 mg/kg midazolam, a continuous infusion of ketamine (0.5 mg . kg(-1) . h(-1)) was used until the end of surgery whereas the placebo group received a volume-equivalent placebo infusion. Ramsey Sedation Scale (RSS) was used for assessing the sedation level. Venous blood and synovial membrane tissue samples were obtained before ketamine infusion, at 30 min of tourniquet ischemia, and at 5 min after tourniquet deflation for MDA and HPX measurements. Tissue MDA and HPX levels were significantly less in the ketamine group than the control group after reperfusion. RSS scores were higher in the ketamine group without any adverse effect. We conclude that ketamine sedation attenuates lipid peroxidation markers in arthroscopic knee surgery with tourniquet application.

Lower limb ischaemia and reperfusion injury in healthy volunteers measured by oxidative and inflammatory biomarkers

“…13 Based on previous studies that have used a pneumatic tourniquet during surgery, this is probably a more realistic timeframe for the production of MDA. 6,9,20,28 In these models, however, the surgical stress might also have contributed to the MDA response. 29 Lipid peroxidation caused by IR of the extremities is one of the most important organic expressions of oxidative stress induced by the reactivity of ROS.…”

Ultrasound-guided femoral and sciatic nerve blocks combined with sedoanalgesia versus spinal anesthesia in total knee arthroplasty

“…The control of tourniquet pain with sedoanalgesia is preferred to anesthesia methods that increase the injury risk by using blocks with a longer duration. Saricaoglu et al [24] found that the use of ketamine and sedoanalgesia with a tourniquet for arthroscopy decreased the malonyl dialdehyde and hypoxanthine levels, which are related to ischemia/reperfusion injury. By maintaining the local anesthetic dose at a low level using only sciatic and femoral blocks in high-risk patients during general and regional anesthesia, TKA is possible with the aid of USG.…”

The effects of ketamin and lidocaine on free radical production after tourniquet-induced ischemia-reperfusion injury in adults

“…In many studies, ketamine's effects on IRI were evaluated with different biomarkers. [8,22] Saricaoglu et al [8] studied the effect of ketamine sedation on oxidative stress during arthroscopic knee surgery with tourniquet application by determining blood and tissue malonyldialdehyde (MDA) and hypoxanthine (HPX) levels, and they concluded that ketamine sedation attenuates lipid peroxidation markers. In this study, the inexpensive ischemic early detection sensitive biomarker IMA was analyzed; and in both ischemia and reperfusion period, ketamine exert protective effects on skeletal IRI.…”

“…[4][5][6] Ketamine, an N-methyl-D-aspartate antagonist, is a dissociative anesthetic agent that was found to attenuate IRIinduced lipid peroxidation in various tissues, such as brain, myocardium, and skeletal muscle. [7][8][9] Lidocaine has been reported to attenuate the IRI injury [10] and the I/R-induced inflammatory response. [11] So far there is no study that compared the effect of these two agents on tourniquet-induced skeletal IRI injury.…”