Colloid Preloading Vs Co-loading During Tourniquet Deflation: An Assessment of Haemodynamic Stability in Total Knee Replacement

Abstract

Introduction: Tourniquet is an essential part of orthopaedic limb surgeries to limit blood loss and achieve a bloodless field during surgery. Some case reports of life-threatening events at the time of deflating tourniquet prompted us to study the impact of tourniquet release on haemodynamics during knee arthroplasty surgery. This study intended to determine the effect of preloading with 6% HES (130/0.4) on the haemodynamic parameters during tourniquet deflation. Methods: This prospective randomized clinical investigation was undertaken at a tertiary care centre after obtaining written informed consent from ASA I&II patients scheduled for elective total knee arthroplasty under spinal anaesthesia, belonging to the age group of 18 and 60 years. The participants were randomized to two groups (group-1 and 2) of 30 each. In group-1 HES given at 5 ml/kg over 30 minutes before tourniquet deflation and in group-2 colloid infusion done based on haemodynamics after tourniquet release. Baseline vitals and tourniquet pre-release value(T0) compared with 1 minute (T1) to 11 minutes (T11) of post-release vitals. Results: Post-deflation of the tourniquet, in group-1 there was a significant increase in heart rate for 3 minutes(P=0.023), while in group-2 it was high throughout the observation period up to T11(P=0.004). Incidences of 20% fall in MAP as compared to baseline (P=0.02) and 10% fall compared to T0(P=0.04) was significantly higher in group-2. The average MAP was significantly low at T3 in group-1 while it was significantly low through T1 to T5 in group-2, compared to T0. Conclusions: Tourniquet release induced hypotension need attention. Preloading with colloids reduces overall hypotensive episodes.