BACKGROUND: The hemodynamic and metabolic effects of tourniquet application undergoing knee surgery with general anesthesia in elderly patients with hypertension have been rarely reported. We evaluated the hemodynamic and metabolic effects in elderly patients compared with young adults. METHODS: Thirty elderly patients (elderly hypertension group, 71.8 +/- 3.9 years) with chronic hypertension undergoing total knee replacement and 30 young adults (normal group, 33.1 +/- 5.1 years) undergoing knee surgery were studied. Mean arterial pressure (MAP), heart rate, cardiac index (CI) by esophageal doppler method, and systemic vascular resistance index (SVRI) were measured before, during, and after tourniquet application. pH, PaO2, PaCO2, Hb and lactate blood concentrations were also measured. RESULTS: MAP increased 25% and 16% in elderly hypertension and normal groups during inflation, respectively (P < 0.05) and returned to basal values after deflation. CI increased to 30% higher than basal values in both groups after deflation (P < 0.05). SVRI decreased 31% and 19% in elderly hypertension and normal groups after deflation, respectively (P < 0.05). After deflation, PaCO2 and lactate increased (P < 0.05). CONCLUSIONS: Elderly patients with hypertension have the significant hemodynamic changes during and after tourniquet application than before, however, there are no differences compared to normal group. These elderly patients should be needed the active hemodynamic monitoring due to the lower compensatory ability.
Aged* ; Anesthesia, General ; Arterial Pressure ; Arthroplasty, Replacement, Knee ; Heart Rate ; Hemodynamics* ; Humans ; Hydrogen-Ion Concentration ; Hypertension* ; Inflation, Economic ; Knee* ; Lactic Acid ; Tourniquets* ; Vascular Resistance ; Young Adult

PURPOSE: Physical restraint may be more frequently done in the emergency departments (ED). The purpose of this study was to identify the frequency, method, and the complication of physical restraint use in an ED. METHOD: All restrained patients in the Chungnam National University Hospital ED were prospectively enrolled from April to December 2004. They were restrained on a bed in the supine position by using an elastic and a cotton band. A restraint checklist was completed by the emergency physician on all patients who were restrained in the ED. RESULT: One hundred thirty-six patients were restrained (0.56% of the total ED visits). The mean age was 55.4+/-18.9 years(range 4~95). Ninety-two patients(67.6%) were men. Most patients were restrained for confusion(53.7%) and agitation(40.4%), and the most patients(87.5%) were restrained for less than 24 hours. Thirty-seven patients (27.2%) had chemical restraint in addition to physical restraint. Medical records about restraint were absent in 86% of the cases. Four patients(2.9%) developed complications such as increased agitation(3) and untied restraint (1). CONCLUSION: This study demonstrated low incidences of restraint-related complications and of documentation of restraint events, therapeutic manual for ED restraint is required.
Checklist ; Chungcheongnam-do ; Cross-Sectional Studies* ; Emergencies* ; Emergency Service, Hospital* ; Hospitals ; Humans ; Incidence ; Male ; Medical Records ; Prospective Studies ; Restraint, Physical* ; Supine Position