Preoperative stellate ganglion blockade prevents tourniquet‐induced hypertension during general anesthesia

Arai, Y‐C. P.; Ogata, Junichi; Matsumoto, Y; Yonemura, H.; Kido, Kenji; Uchida, Tatsuo; Ueda, Wasa

doi:10.1111/j.0001-5172.2004.00389.x

Cited by 19 publications

(10 citation statements)

References 30 publications

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“…We recruited elderly female patients for this study irrespective of the presence of hypertension or diabetes. Therefore, the outcome of this investigation could be clinically useful for the treatment of vulnerable patients compared with other studies using healthy subjects 5-7.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a sample size of five per group was calculated as being needed to show a difference of maximum SAP through 25 and 30 mmHg (SD 9 mmHg) between groups with an α risk of 0.01 and a β risk of 0.1 7. However, we recruited 15 patients for each group.…”

Section: Methodsmentioning

confidence: 99%

“…These hemodynamic changes are minimal in healthy young patients but may not be tolerated by older patients with poor cardiac reserve 4. Previous studies have only focused on the management of delayed tourniquet-induced hypertension in young patients 4-7.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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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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“…It has been suggested that TIH & tachycardia denote activation of the sympathetic nervous system in response to the development of tourniquet pain [16]. The aim of this study was to test the effectiveness of combined lumbar plexus block and sciatic nerve block in lessening TIH.…”

Section: Introductionmentioning

confidence: 98%

Combined Sciatic-Lumbar Plexus Block with General Anesthesia: Efficacy in Preventing Tourniquet-Induced Hemodynamic Changes

Mostafa¹

2018

OJAnes

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Background: Pneumatic arterial tourniquet is a utilized strategy in limb surgeries to provide bloodless field to facilitate surgical procedure. Be that as it may, arterial tourniquet has numerous injurious impacts including hemodynamic changes and tourniquet-induced pain which sometimes can be severe and intolerable. Objectives: Our primary aim was to assess the impact of performing "Lumbar Plexus Block and sciatic nerve block" with General Anesthesia (GA) on the degree of arterial tourniquet-induced hemodynamic effects. On the other hand, our secondary aims were: amount of postoperative analgesic prerequisites, patient satisfactory score and documented side effects. Settings and Design: Ain Shams University, Orthopedic operating theatre; a prospective, randomized, double-blind study. Methods and Material: The physical status of 50 patients (both sexes) including I and II patients from American Society of Anesthesiologists, whose ages are from 20-40 years, is not so ideal when they are undergoing elective knee Arthroscopy. The duration lasts no more than ninety minutes under GA with application of tourniquet. Patients were allotted haphazardly to one of two groups. In Group C (Control group): Only GA. In Group B: LPB and sciatic nerve block were performed just before GA administration. Intraoperative hemodynamics was recorded at specific timings. Results: Incidence of tourniquet induced hypertension (TIH) was markedly less with Group B at: forty five, sixty, seventy five mins after tourniquet inflation and just before tourniquet deflation. Also, the total ketorolac consumption during first 24 hours of postoperative period was significantly less with Group B (p < 0.001). Finally, patient satisfaction was significantly higher in Group B. Conclusions: Combined Sciatic-Lumbar plexus blocks when combined with general anesthesia were very effective in attenuating TIH.

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“…[5] In the past various drugs have been used prophylactically to decrease TIH like Clonidine [6] , ketamine [7] , magnesium [8] , and methods like stellate ganglion block have also been used for the same. [9] Although the mechanism of TIH is not well understood, the autonomic nervous system plays an important role. [10] Hence, dexmedetomidine, a potent a 2 -adrenoceptor agonist may prevent hyper adrenergic responses and can be of prophylactic value for tourniquet induced hypertension.…”

Section: Introductionmentioning

confidence: 99%

Role of Low Dose Preoperative Dexmedetomidine in Preventing Tourniquet Induced Hypertension in Paediatric Orthopaedic upper Limb Surgeries during General Anaesthesia

Ali¹,

Siraj²,

Athar³

et al. 2016

AIMDR

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Background: Pneumatic Tourniquets are commonly used in orthopaedic surgery of the extremities to reduce bleeding and to provide a clear field to the surgeon, but severe pain often complicates the tourniquet inflation. Although the mechanism of tourniquet induced hypertension (TIH)is not well understood, the autonomic nervous system plays an important role. Hence, Dexmedetomidine, a potent a2-adrenoceptor agonist may prevent hyper adrenergic responses and can be of prophylactic value for tourniquet induced hypertension. Methods: Forty American Society of Anesthesiologists (ASA) physical status class I and II children, aged 5-12 years, posted for Orthopaedic surgery of upper limbs under general anaesthesia with tourniquet application were included in the study. They were randomly assigned to receive intravenous Dexmedetomidine (Group D; n=20) or normal saline (Group C; n=20) before tourniquet inflation. Incidence of TIH, Mean Arterial blood pressure and heart rate were recorded. Results: There were no significant differences between the baseline characteristics. The incidence of TIH in group D was significantly less than the group C (20%) as compared to group D (70%).There was significant increase in the heart rate of placebo group after 30 minutes of tourniquet inflation while there was minimal variability of heart rate in the group D. In the group D, arterial pressure was not significantly changed, but in the group C, the arterial pressure was significantly increased after 20 minutes of tourniquet inflation. No significant adverse effects were noted in any group. Conclusion: Preoperative low dose intravenous Dexmedetomidine prevents tourniquetinduced hypertension in paediatric patients undergoing general anaesthesia for upper limb surgeries.

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Preoperative stellate ganglion blockade prevents tourniquet‐induced hypertension during general anesthesia

Abstract: Ipsilateral SGB attenuated the hyperdynamic response mediated by prolonged tourniquet inflation during knee arthroscopy.

Cited by 19 publications

References 30 publications

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

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

Combined Sciatic-Lumbar Plexus Block with General Anesthesia: Efficacy in Preventing Tourniquet-Induced Hemodynamic Changes

Role of Low Dose Preoperative Dexmedetomidine in Preventing Tourniquet Induced Hypertension in Paediatric Orthopaedic upper Limb Surgeries during General Anaesthesia

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Preoperative stellate ganglion blockade prevents tourniquet‐induced hypertension during general anesthesia

Abstract: Ipsilateral SGB attenuated the hyperdynamic response mediated by prolonged tourniquet inflation during knee arthroscopy.

Cited by 19 publications

References 30 publications

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

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

Combined Sciatic-Lumbar Plexus Block with General Anesthesia: Efficacy in Preventing Tourniquet-Induced Hemodynamic Changes

Role of Low Dose Preoperative Dexmedetomidine in Preventing Tourniquet Induced Hypertension in Paediatric Orthopaedic upper Limb Surgeries during General Anaesthesia

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

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