African Health Sciences
Makerere University Medical School
Vol. 17, No. 1, 2017, pp. 122-132
Bioline Code: hs17016
Full paper language: English
Document type: Research Article
Document available free of charge
African Health Sciences, Vol. 17, No. 1, 2017, pp. 122-132
© Copyright  - African Health Sciences
A randomized controlled trial to assess the effect of a ketamine infusion on tourniquet hypertension during general anaesthesia in patients undergoing upper and lower limb surgery.|
Ongaya, Joyce; Mung’ayi, Vitalis; Sharif, Thikra & Kabugi, Jimmie
Background: Tourniquet hypertension arising from tourniquet inflation remains a primary concern to the anaesthetist. One
drug commonly used to manage tourniquet hypertension is ketamine. No studies have examined the effect of ketamine on tourniquet
hypertension for a period of more than one hour or an infusion of the same.
Objective: To compare the effect of an intravenous infusion of ketamine versus placebo on tourniquet induced hypertension
in patients undergoing upper and lower limb surgery under general anaesthesia.
Methods: Forty six adult patients scheduled for upper and lower limb surgery under general anaesthesia were randomized into
two equal groups. The ketamine group received an intravenous bolus of 0.1mg/kg of ketamine followed by an infusion of
2ug/kg/min. The saline group received an intravenous bolus of physiological saline followed by an infusion of saline. All the
patients were reviewed post-operatively. Data of the baseline characteristics, haemodynamic changes, post-tourniquet pain and
side effects were collected. If post-tourniquet pain was present post-operatively, a visual analogue scale (VAS) was used to assess
Results: 46 patients successfully completed the trial. There were no significant differences between the groups for baseline
patient demographics. The incidence of tourniquet hypertension was higher in the saline group (26.1%) compared with ketamine
group (4.6%) with a 95% confidence interval. The difference was shown to be statistically significant (‘P’<0.05). There
was an increase in systolic blood pressure after 60 minutes of tourniquet inflation in the saline group but the difference was not
statistically significant(‘P’>0.866). There were no significant differences between the groups as regards diastolic blood pressure
and heart rate. VAS scores did not differ between the two groups. Statistically, there was no difference found between the two
groups. Side effects were minimal in the ketamine group whilst in the saline group, nausea and vomiting were predominant but
were also not statistically significant.
Conclusion: Based on the results of this study,there was a difference in the proportion of tourniquet hypertension between
the ketamine and saline groups for patients undergoing upper and lower limb orthopaedic surgery under general anaesthesia.
Randomized controlled trial; effect of a ketamine infusion; tourniquet hypertension; general anaesthesia; upper and lower limb surgery