Dexmedetomidine Reduces the Ischemia-Reperfusion Injury Markers During Upper Extremity Surgery With Tourniquet

• Published in: The Journal of hand surgery (American ed.) Vol. 33; no. 6; pp. 941 - 947
• Main Authors: Yagmurdur, Hatice, MD, Ozcan, Namik, MD, Dokumaci, Fatma, MD, Kilinc, Kamer, PhD, Yilmaz, Fatma, MD, Basar, Hulya, MD
• Format: Journal Article
• Language: English
• Published: New york, NY Elsevier Inc 01-07-2008; Elsevier
• Subjects: Adrenergic alpha-Agonists - therapeutic use; Adult; Alanine Transaminase - blood; Analysis of Variance; Arm - blood supply; Arm - surgery; Aspartate Aminotransferases - blood; Biological and medical sciences; Biomarkers - blood; Cardiology. Vascular system; Creatine Kinase - blood; Creatinine - blood; Dexmedetomidine; Dexmedetomidine - therapeutic use; Diseases of the osteoarticular system; extremity; Female; Humans; Hypoxanthine - blood; ischemia-reperfusion injury; L-Lactate Dehydrogenase - blood; Lipid Peroxidation - drug effects; lipid peroxides; Male; Malondialdehyde - blood; Medical sciences; Middle Aged; Orthopedics; Reperfusion Injury - blood; Reperfusion Injury - prevention & control; Statistics, Nonparametric; tourniquet; Tourniquets; Uric Acid - blood; ischemia-reperfusion injury; tourniquet; lipid peroxides; Dexmedetomidine; extremity; α2-Adrenergic receptor; Tourniquet; Agonist; Ischemia reperfusion; Lipids; Upper extremity; Treatment; Surgery; Orthopedics; α-Adrenergic receptor agonist; Upper limb; Peroxides
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2008.01.014

Purpose 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 μg/kg for 10 minutes, followed by 0.5 μg 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. Type of study/level of evidence Prognostic II.