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ANESTHETIC PHARMACOLOGY

Preoperative Oral Dextromethorphan Attenuated Tourniquet-Induced Arterial Blood Pressure and Heart Rate Increases in Knee Cruciate Ligament Reconstruction Patients Under General Anesthesia

Soichiro Yamashita, MD^*, Hiroshi Yamaguchi, MD, Yu Hisajima, MD^*, Kazuhiro Ijima, MD^*, Kaori Saito, MD^*, Ai Chiba, MD^*, and Toru Yasunaga, MD

Departments of *Anesthesia and Critical Care Medicine and Orthopedics, Iwaki Kyoritsu General Hospital, Iwaki, Fukushima, Japan; and Department of Anesthesia, Ryugasaki Saiseikai Hospital, Ryugasaki, Ibaraki, Japan

Address correspondence and reprint requests to Soichiro Yamashita, MD, Acute Care Neurology, Division of Brain Injury Outcomes, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Jefferson 1-109, Baltimore, MD 21287. Address e-mail to soichi2003{at}aol.com

The precise mechanism of tourniquet-induced arterial blood pressure increase is unknown. We determined the effect of preoperative oral dextromethorphan (DM) on arterial blood pressure and heart rate changes during tourniquet inflation in knee cruciate ligament reconstruction patients under general anesthesia. Patients in the DM group (n = 38) received oral DM 30 mg, and patients in the control group (n = 38) received oral placebo 2 h before the induction of anesthesia. Anesthesia was maintained with sevoflurane 2.0% and N₂O in 33% oxygen, and the trachea was intubated until the end of surgery. Arterial blood pressure and heart rate were measured at 0, 30, and 60 min after the start of tourniquet inflation. Systolic arterial blood pressure and heart rate at 60 min in the control group were significantly more than those in the DM group (131.1 ± 15.8 mm Hg versus 123.6 ± 15.9 mm Hg [P < 0.05] and 74.1 ± 11.3 bpm versus 67.8 ± 8.5 bpm [P < 0.01], respectively). The percentage increase in systolic arterial blood pressure and heart rate in the DM group was also attenuated when compared with that in the control group (P < 0.05). In conclusion, preoperative oral DM 30 mg significantly attenuated arterial blood pressure and heart rate increases during tourniquet inflation under general anesthesia.

IMPLICATIONS: We demonstrated that preoperative oral dextromethorphan 30 mg significantly attenuated arterial blood pressure and heart rate increases at 60 min during tourniquet inflation in patients undergoing knee cruciate ligament reconstruction under general anesthesia.