Effect of Spinal or Sevoflurane Anesthesia on Neutrophil Activation During Knee Surgery With Pneumatic Tourniquet

Study Overview
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Brief Summary
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Aim of study : Assessement of neutrophil activation during ischemia reperfusion associated with tourniquet use for total knee arthroplasty. This activation was compared in a group of patient scheduled for spinal anesthesia and for sevoflurane anesthesia

Detailed Description
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Aim of study : Assessement of neutrophil activation during ischemia reperfusion associated with tourniquet use for total knee arthroplasty. This activation was compared in a group of patient scheduled for spinal anesthesia and for sevoflurane anesthesia This activation was assessed by plasma myeloperoxidase and elastase measurements in four consecutive blood samples during and after surgery (before surgical incision and 1, 3, 24 hours following tourniquet release.

Official Title
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Effect of Spinal or Sevoflurane Anesthesia on Neutrophil Activation After Tourniquet Induced Ischemia-reperfusion in Knee Surgery

Conditions
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Knee Surgery With Tourniquet

Intervention / Treatment
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* Drug: Sevoflurane Volatile Liquid
* Drug: Bupivacaine / SUFentanil


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Total knee arthroplasty under spinal or sevoflurane anesthesia Exclusion Criteria: American Society of Anesthesiologists class 3 and 4 vascular disease of the lower limbs cardiac or respiratory disease immune disorder

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Non-Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Group Spinal anesthesia<br>Knee surgery under spinal anesthesia Intervention involves spinal administration of 12,5 mg bupivacaine and 2,5 microgram sufentanil. | Drug: Bupivacaine / SUFentanil<br> <br> |
| Active Comparator: Group Sevoflurane anesthesia<br>Knee surgery under sevoflurane anesthesia Intervention involves administration of inhaled sevoflurane for maintenance of general anesthesia | Drug: Sevoflurane Volatile Liquid<br> <br> |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in plasmatic concentration of myeloperoxidase and elastase | Biological measurement of changes in plasmatic concentration of myeloperoxidase and elastase from preoperative values to one hour after tourniquet release. | Before surgical incision and one hour after tourniquet release | 
| Changes in plasmatic concentration of myeloperoxidase and elastase | Biological measurement of changes in plasmatic concentration of myeloperoxidase and elastase from preoperative values to 3 and 24 hours after tourniquet release. | Before surgical incision then 3 and 24 hours after tourniquet release | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Changes in plasmatic concentration of endothelial biomarkers | Biological measurement of changes in plasmatic concentration of syndecan-1, soluble thrombomodulin, soluble E-selectin and VEGF from preoperative values to one hour after tourniquet release. | Before surgical incision and one hour after tourniquet release | 
| Changes in plasmatic concentration of endothelial biomarkers | Biological measurement of changes in plasmatic concentration of syndecan-1, soluble thrombomodulin, soluble E-selectin and VEGF from preoperative values to 3 and 24 hours after tourniquet release. | Before surgical incision then 3 and 24 hours after tourniquet release | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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total knee arthroplasty, tourniquet, sevoflurane, spinal anesthesia, myeloperoxidase, elastase, neutrophil