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 and maintained 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 6 h (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.