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Cardiovascular Effects of Tourniquet Application with Cardiac Cycle Efficiency: A Prospective Observational Study
Merve Seker1, Serap Aktas Yildirim1, Halim Ulugol1
1Department of Anesthesiology and Reanimation, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul 34752, Turkey.
Insights
Tourniquets reduce cardiac efficiency during surgery. Combined spinal epidural anesthesia (CSEA) may lessen this impact compared to general anesthesia (GA), suggesting CSEA offers better cardiac protection.
Area of Science:
- Anesthesiology
- Cardiovascular Physiology
- Surgical Innovation
Background:
- The effect of surgical tourniquets on cardiac efficiency is not well understood.
- Tourniquets are commonly used in orthopedic surgery, particularly for total knee arthroplasty (TKA).
- Different anesthesia techniques may influence the cardiovascular response to tourniquet application.
Purpose of the Study:
- To assess the impact of tourniquets on cardiac cycle efficiency (CCE).
- To compare the effects of general anesthesia (GA) and combined spinal epidural anesthesia (CSEA) on CCE during TKA.
- To analyze cardiac energy parameters under different anesthesia and tourniquet conditions.
Main Methods:
- Prospective observational study of 43 patients undergoing elective unilateral TKA.
- Patients were divided into two groups: GA (n=22) and CSEA (n=21).
- Cardiac energy parameters, including CCE, were measured at multiple time points: pre-anesthesia, pre-tourniquet, during tourniquet inflation, and post-deflation.
Main Results:
- CCE significantly decreased more in the GA group compared to the CSEA group upon tourniquet inflation.
- dP/dt and Ea (measures of cardiac contractility and workload) increased more in the GA group.
- Post-deflation, CCE increased in the GA group, while dP/dt and Ea decreased, indicating compensatory changes.
Conclusions:
- Tourniquet application reduces cardiac efficiency, likely due to compensatory cardiovascular responses.
- CSEA appears to mitigate the negative impact of tourniquets on cardiac efficiency compared to GA.
- CSEA may be a preferred anesthetic choice for TKA when tourniquet use is necessary to preserve cardiac function.
Abstract:
Objectives: The impact of the tourniquet on cardiac efficiency remains unknown. This study aimed to assess the impact of the tourniquet on cardiac cycle efficiency (CCE) and to interpret how general anesthesia (GA) or combined spinal epidural anesthesia (CSEA) affects this during surgery using cardiac energy parameters. Methods: This prospective observational study included 43 patients undergoing elective unilateral total knee arthroplasty (TKA) with a tourniquet divided into GA (n = 22) and CSEA (n = 21) groups. Cardiac energy parameters were measured before anesthesia (T1), pre-tourniquet inflation (T2), during inflation (T3-T8), and post-deflation (T9). The estimated power of the study was 0.99 based on the differences and standard deviations in CCE at T2-T3 for all patients (effect size: 0.88, alpha error: 0.05). Results: CCE decreased significantly more at T3 in the GA group than in the CSEA group, whereas dP/dt and Ea increased more (p < 0.05, p < 0.001, and p < 0.01, respectively). At T9, CCE increased significantly in the GA group, whereas dP/dt and Ea decreased (p < 0.05, p < 0.001, and p < 0.001, respectively). Conclusions: The tourniquet reduces cardiac efficiency through compensatory responses, and CSEA may mitigate this effect.
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