Dexmedetomidine reduces the ischemia-reperfusion injury markers during upper extremity surgery with tourniquet.
OBJECTIVE
We examined the effect of dexmedetomidine on ischemia-reperfusion injury due to tourniquet application during upper-extremity surgery by determining blood malondialdehyde and hypoxanthine levels. Alterations in aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, lactate dehydrogenase, uric acid, and creatinine levels were also assessed.


METHODS
Forty patients of American Society of Anesthesiologists physical status I to II having hand and forearm surgery with tourniquet were randomly allocated into 2 groups. Brachial plexus anesthesia via axillary approach was performed for upper-limb block in all patients. In the dexmedetomidine group, a continuous infusion of dexmedetomidine (1 microg/kg for 10 minutes, followed by 0.5 microg kg(-1) h(-1)) was used until the end of surgery, whereas the control group received an equivalent volume of saline. Venous blood samples were obtained before brachial plexus anesthesia, at 1 minute before tourniquet release, and 15 minutes after tourniquet release for biochemical analysis.


RESULTS
Dexmedetomidine significantly attenuated plasma hypoxanthine production in the ischemia and plasma malondialdehyde production in the reperfusion periods. Blood creatine phosphokinase and uric acid levels were significantly lower in the dexmedetomidine group compared with those in the control group after reperfusion.


CONCLUSIONS
Our results suggest that dexmedetomidine may offer advantages by inhibiting lipid peroxidation in the case of anticipated ischemia-reperfusion injury, such as would occur in upper-extremity surgery requiring tourniquet application.


METHODS
Prognostic II.
Yagmurdur
Hatice
H
Clinic of Anesthesiology and Reanimation, The Ministry of Health Ankara Research and Training Hospital, Ankara, Turkey. hyagmurdur@yahoo.com
Ozcan
Namik
N
Dokumaci
Fatma
F
Kilinc
Kamer
K
Yilmaz
Fatma
F
Basar
Hulya
H
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D001132:Arm / Q000098:blood supply / Q000601:surgery*; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D020927:Dexmedetomidine / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019271:Hypoxanthine / Q000097:blood; D007770:L-Lactate Dehydrogenase / Q000097:blood; D015227:Lipid Peroxidation / Q000187:drug effects; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D015427:Reperfusion Injury / Q000097:blood / Q000517:prevention & control*; D018709:Statistics, Nonparametric; D014111:Tourniquets; D014527:Uric Acid / Q000097:blood
D000316:Adrenergic alpha-Agonists; D015415:Biomarkers; D014527:Uric Acid; D019271:Hypoxanthine; D008315:Malondialdehyde; D020927:Dexmedetomidine; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase