Key result
Tourniquet inflation triggers similar MAP increases in elderly hypertensive patients and young healthy adults.
Why the study?
The hemodynamic and metabolic effects of tourniquet application during knee surgery under general anesthesia in elderly patients with hypertension have been rarely reported.
Does tourniquet application during knee surgery cause different hemodynamic and metabolic changes in elderly patients with hypertension compared to young adults?
Observational (n=60)
No
Does tourniquet application during knee surgery cause different hemodynamic and metabolic changes in elderly patients with hypertension compared to young adults?
Elderly patients with hypertension experience significant hemodynamic changes during and after tourniquet application for knee surgery, similar in magnitude to young adults, but require active monitoring due to lower compensatory ability.
Comparable tourniquet-induced MAP/SVRI shifts in elderly hypertensives and controls; leaves open whether compensatory reserve warrants intensified monitoring.
Background: The hemodynamic and metabolic effects of tourniquet application undergoing knee surgery with general anesthesia in elderly patients with hypertension have been rarely reported.We evaluated the hemodynamic and metabolic effects in elderly patients compared with young adults.Methods: Thirty elderly patients (elderly hypertension group, 71.8 ± 3.9 years) with chronic hypertension undergoing total knee replacement and 30 young adults (normal group, 33.1 ± 5.1 years) undergoing knee surgery were studied.Mean arterial pressure (MAP), heart rate, cardiac index (CI) by esophageal doppler method, and systemic vascular resistance index (SVRI) were measured before, during, and after tourniquet application.pH, PaO2, PaCO2, Hb and lactate blood concentrations were also measured.Results: MAP increased 25% and 16% in elderly hypertension and normal groups during inflation, respectively (P ＜ 0.05) and returned to basal values after deflation.CI increased to 30% higher than basal values in both groups after deflation (P ＜ 0.05).SVRI decreased 31% and 19% in elderly hypertension and normal groups after deflation, respectively (P ＜ 0.05).After deflation, PaCO2 and lactate increased (P ＜ 0.05).Conclusions: Elderly patients with hypertension have the significant hemodynamic changes during and after tourniquet application than before, however, there are no differences compared to normal group.These elderly patients should be needed the active hemodynamic monitoring due to the lower compensatory ability.(Korean J Anesthesiol 2006; 51: 695∼700)
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Kim et al. (2006) conducted an observational in Hypertension in patients undergoing knee surgery with tourniquet (n=60). Elderly age with chronic hypertension vs. Young healthy adults was evaluated on Increase in mean arterial pressure (MAP) during tourniquet inflation (p=<0.05). Elderly patients with hypertension experienced an 18% increase in mean arterial pressure during tourniquet inflation, which was not significantly different from the 15% increase observed in young healthy adults.
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