The Effects of Spinal, Inhalation, and Total Intravenous Anesthetic Techniques on Ischemia-Reperfusion Injury in Arthroscopic Knee Surgery

Purpose. To compare the effects of different anesthesia techniques on tourniquet-related ischemia-reperfusion by measuring the levels of malondialdehyde (MDA), ischemia-modified albumin (IMA) and neuromuscular side effects. Methods. Sixty ASAI-II patients undergoing arthroscopic knee surgery were randomised to three groups. In Group S, intrathecal anesthesia was administered using levobupivacaine. Anesthesia was induced andmaintained with sevoflurane in Group I and TIVA with propofol in Group T. Blood samples were obtained before the induction of anesthesia (t(1)), 30 min after tourniquet inflation (t(2)), immediately before (t(3)), and 5 min (t(4)), 15 min (t(5)), 30 min (t(6)), 1 h (t(7)), 2 h (t(8)), and 6h (t(9)) after tourniquet release. Results. MDA and IMA levels increased significantly compared with baseline values in Group S at t(2)-t(9) and t(2)-t(7). MDA levels in Group T and Group I were significantly lower than those in Group S at t(2)-t(8) and t(2)-t(9). IMA levels in Group T were significantly lower than those in Group S at t(2)-t(7). Postoperatively, a temporary 1/5 loss of strength in dorsiflexion of the ankle was observed in 3 patients in Group S and 1 in Group I. Conclusions. TIVA with propofol can make a positive contribution in tourniquet-related ischemia-reperfusion.