Comparison of ketorolac and low-dose ketamine in preventing tourniquet-induced increase in arterial pressure

Comparison of bolus administration effects of lidocaine on preventing tourniquet-induced hypertension in patients undergoing general anesthesia: a randomized controlled trial

Background

This study assessed the effect of a single bolus administration of lidocaine on the prevention of tourniquet-induced hypertension (TIH) and compared the effect of lidocaine to that of ketamine in patients undergoing general anesthesia.

Methods

This randomized, controlled, double-blind study included 75 patients who underwent lower limb surgery using a tourniquet. The patients were administered lidocaine (1.5 mg/kg, n = 25), ketamine (0.2 mg/kg, n = 25) or placebo (n = 25). The study drugs were administered intravenously 10 min before tourniquet inflation. Systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) were measured before tourniquet inflation, after tourniquet inflation for 60 min at 10 min intervals, and immediately after tourniquet deflation. The incidence of TIH, defined as an increase of 30% or more in SBP or DBP during tourniquet inflation, was also recorded.

Results

SBP, DBP, and HR increased significantly over time in the control group compared to those in the lidocaine and ketamine groups for 60 min after tourniquet inflation (P < 0.001, P < 0.001, and P = 0.007, respectively). The incidence of TIH was significantly lower in the lidocaine (n = 4, 16%) and ketamine (n = 3, 12%) group than in the control group (n = 14, 56%) (P = 0.001).

Conclusion

Single-bolus lidocaine effectively attenuated blood pressure increase due to tourniquet inflation, with an effect comparable to that of bolus ketamine.

Femoral artery block (FAB) attenuates thigh tourniquet-induced hypertension: a prospective randomized, double-blind, placebo-controlled trial

INTRODUCTION

Prolonged tourniquet inflation during surgery frequently leads to tourniquet hypertension (TH), which is thought to arise from compression of A-δ fibers leading to sympathetically mediated C fiber activation. In the lower extremity, C fibers and other sympathetic nerve fibers are carried along the femoral artery. We hypothesized that blockade of these fibers at the femoral artery would decrease the incidence of TH.

METHODS

Thirty American Society of Anesthesia 1-3 patients aged 18-75 undergoing total ankle arthroplasty were randomized to receive 15 mL of injectate (mepivacaine 1.5% or saline placebo) at the anteromedial aspect of the common femoral artery at the level of the inguinal crease under ultrasound guidance. Both groups received preoperative popliteal sciatic and saphenous nerve blocks for analgesia and a standardized general anesthetic. Esmolol was administered if systolic blood pressure rose >30% above baseline. Incidence of TH was the primary outcome.

RESULTS

TH was present in 93.3% of sham patients versus 33.3% of block patients. Mean systolic pressure at 120 min and 150 min of tourniquet time was significantly higher in the sham group compared with the block group. Esmolol requirement (95.3+107.6 v 8.0+14.2, p=<0.001) was also significantly higher in the sham group. No differences were noted in pain scores or opioid consumption, and no patient experienced sensory or motor block of the femoral nerve.

DISCUSSION

Under these experimental conditions, injection of local anesthetic around the femoral artery reduced the incidence of TH and intraoperative esmolol requirement.

TRIAL REGISTRATION NUMBER

www.clinicaltrials.gov (NCT03390426; December 28, 2017).

Anesthetic efficacy of ketamine, ketamine-tramadol and ketamine-ketorolac in chicks

BACKGROUND

Ketamine produces ordinary general anesthesia characterized by weak hypnosis and analgesia leading to complications during surgical operations.

AIMS

The aim of this study was to evaluate the combination of ketorolac or tramadol to enhance ketamine anesthesia in 7 to 20-day-old chicks and its feasibility and practical application for induction of general anesthesia in veterinary medicine.

METHODS

Hypnotic and analgesic Median Effective Doses (ED_50s) of ketamine alone and combination with tramadol or ketorolac were determined by the up-and-down method, then the ED₅₀ values of these combinations were used for measurement of hypnotic and analgesic criteria moreover, their effect on serum Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) was assayed.

RESULTS

Ketamine hypnosis and analgesia were increased when mixed with tramadol (26 and 39%) or ketorolac (27 and 40%), respectively. Ketamine-ketorolac mixture was better combination of inducing the faster onset of anesthesia and short recovery with the longest duration of action and enhancing analgesia when compared to ketamine alone or in combination with tramadol and is preferred for induction of anesthesia. The liver function enzymes, including AST and ALT, showed no significant difference among all above mentioned groups.

CONCLUSION

The data of this experimental study reveal the superiority of using ketorolac (instead of tramadol) in combination with ketamine for induction of general anesthesia in the chicks.