Comparison between the Effect of Trendelenburg 20 Degree and Straight Leg Raising 45 Degree Positions on The Hemodynamics After Tourniquet Deflation in Knee Arthroscopy

Abstract

Background: Deflation of the pneumatic tourniquet after orthopedic surgery is associated with multiple cardiovascular adverse effects [hypotension and tachycardia]. Trendelenburg position or passive leg raising [PLR] are commonly used as the initial treatment of shock and hypotension Aim of the work: To compare between Trendelenburg position 20˚ and passive leg raising 45° regarding the incidence of post-tourniquet deflation cardiovascular adverse effects in patients undergoing unilateral knee arthroscopy. Patients and methods: This prospective study included 98 cases that underwent unilateral knee arthroscopy. Patients were randomly allocated into two groups; group [1] included 49 cases who were exposed to the Trendelenburg position after deflation, and group [2] included the remaining cases who had the straight leg raising test after deflation. Mean arterial pressure, heart rate, and need for vasoactive substances were recorded. Results: No significant difference was noticed between the two groups regarding demographic variables, heart rate before tourniquet deflation, and one-minute after its deflation. However, there was a significant difference between the same groups on the subsequent readings apart from the last one. Also, group [1] showed significantly higher mean arterial pressure [MAP] compared to group [2] after deflation. Hypotension was more significantly encountered in group [2], and thus ephedrine requirements were increased. Conclusion: Trendelenburg position appears to be more efficacious when compared to the straight leg raising, regarding the prevention of cardiovascular adverse effects associated with deflation.

Keywords

• trendelenburg position
• straight leg raising test
• tourniquet deflation
• knee surgery
• hypotension