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Anesth Analg 2002;94:1633-1638
© 2002 International Anesthesia Research Society

GENERAL ARTICLES

Quantification and Comparison of Pulmonary Emboli Formation After Pneumatic Tourniquet Release in Patients Undergoing Reconstruction of Anterior Cruciate Ligament and Total Knee Arthroplasty

Kazuyoshi Hirota, MD, Hiroshi Hashimoto, MD, Toshihito Tsubo, MD, Hironori Ishihara, MD, and Akitomo Matsuki, MD

Department of Anesthesiology, University of Hirosaki School of Medicine, Japan

Address correspondence and reprint requests to Kazuyoshi Hirota, MD, Department of Anesthesiology, University of Hirosaki School of Medicine, Hirosaki 036-8562, Japan. Address e-mail to masuika{at}cc.hirosaki-u.ac.jp

The amount of emboli formed (percentage of total emboli area to the right atrial area [%Ae]) after tourniquet release in invasive procedures of the medullary cavity is empirically much larger than that in noninvasive procedures, even if the tourniquet duration is similar. Thus, we compared %Ae between arthroscopic reconstruction of the anterior cruciate ligament (ACL, n = 20) and total knee arthroplasty (TKA, n = 20). The right atrium was continuously monitored by transesophageal echocardiography to assess %Ae. Peak %Ae ± SD (ACL, 4.1% ± 3.4%; TKA, 20.7% ± 16.7%) appeared 30–40 s after tourniquet release in both groups. However, %Ae in the TKA group was always larger than the peak %Ae in the ACL group. In addition, although the ETCO2 significantly increased after tourniquet release in both groups, increase of ETCO2 (1.1% ± 0.3%) in the ACL group was significantly larger than that in the TKA group (0.5% ± 0.2%). An increase in ETCO2 was inversely proportional to peak %Ae (P < 0.01; r = 0.703). Therefore, the present data suggest that the risk of acute pulmonary embolism after tourniquet release may be more frequent during TKA than ACL.

IMPLICATIONS: We compared emboli formation after tourniquet release in patients undergoing arthroscopic reconstruction of the anterior cruciate ligament (ACL, n = 20) and total knee arthroplasty (TKA, n = 20) using transesophageal echocardiography. The present data suggest that the risk of acute pulmonary embolism after tourniquet release could be more frequent during TKA than ACL.




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R. P. A. Janssen and H. A. G. M. Sala
Fatal Pulmonary Embolism After Anterior Cruciate Ligament Reconstruction
Am. J. Sports Med., June 1, 2007; 35(6): 1000 - 1002.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2002 by the International Anesthesia Research Society.