The Effects of 6% Hydroxyethyl Starch on Ischemia - Reperfusion Injury in Total Knee Arthroplasty with Tourniquet Application

We investigated the effects of 6% hydroxyethyl starch (HES) infusion on ischemia-reperfusion injury in total knee arthroplasty using pneumatic tourniquet application. Before induction of spinal anesthesia and 15 minute after tourniquet release, we examined plasma malondialdehyde (MDA) levels to determine the degree of lipid peroxidation after ischemia-reperfusion. Sixty patients of American Society of Anesthesiologists physical status I to II having unilateral total knee arthroplasty with tourniquet randomly assigned into 2 groups. Group NS received normal saline 10ml/kg and group HES received hydroxyethyl starch solution 10ml/kg respectively during spinal anesthesia. Blood samples for the analysis of plasma MDA were drawn twice at before induction and 15 minute after tourniquet release. In group NS, plasma MDA level was not different between before and after tourniquet release (2.20 ± 0.36 nmol/ml, 2.26 ± 0.43nmol/ml, p=0.37). In group HES, plasma MDA level was significantly increased before and after tourniquet (1.84 ± 0.43 nmol/ml, 1.96 nmol/ml, p=0.026). Hydroxyethyl starch solution have no preventive effects on lipid peroxidation after ischemic-reperfusion oxidative stress.