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REGIONAL ANESTHESIA

Ketamine Sedation During Spinal Anesthesia for Arthroscopic Knee Surgery Reduced the Ischemia-Reperfusion Injury Markers

Fatma Saricaoglu, MD^*, Didem Dal, MD^*, Akgün Ebru Salman, MD^*, Mahmut Nedim Doral, MD, Kamer Klnç, MD, and Ülkü Aypar, MD^*

*Department of Anaesthesiology and Reanimation, Department of Sports Medicine and Orthopaedics, and the Department of Biochemistry, Hacettepe University Faculty of Medicine, Ankara, Turkey

Address correspondence and reprint requests to Fatma Saricaoglu, Hacettepe University Medical Faculty, Department of Anaesthesiology and Reanimation, 06100 Sihhiye/Ankara Turkey. Address e-mail to fatmasaricao{at}yahoo.com.

We studied the effect of ketamine sedation on oxidative stress during arthroscopic knee surgery with tourniquet application by determining blood and tissue malonyldialdehyde (MDA) and hypoxanthine (HPX) levels. Thirty ASA I–II patients undergoing arthroscopic knee surgery with tourniquet were randomly divided into two groups. Spinal anesthesia induced with 12.5 mg bupivacaine was administered to all patients. In the ketamine group, after IV administration of 0.01 mg/kg midazolam, a continuous infusion of ketamine (0.5 mg · kg^–1 · h^–1) was used until the end of surgery whereas the placebo group received a volume-equivalent placebo infusion. Ramsey Sedation Scale (RSS) was used for assessing the sedation level. Venous blood and synovial membrane tissue samples were obtained before ketamine infusion, at 30 min of tourniquet ischemia, and at 5 min after tourniquet deflation for MDA and HPX measurements. Tissue MDA and HPX levels were significantly less in the ketamine group than the control group after reperfusion. RSS scores were higher in the ketamine group without any adverse effect. We conclude that ketamine sedation attenuates lipid peroxidation markers in arthroscopic knee surgery with tourniquet application.