Pathophysiologic Hemodynamics After Primary Unilateral Total Hip Arthroplasty (THA)
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Mücərrəd
Təsvir
Early postoperative mobilization is a cornerstone in the so-called fast track multimodal perioperative approach and is essential in preventing postoperative morbidity and reducing hospital length-of-stay. Intact orthostatic blood pressure regulation is essential for early postoperative mobilization. However, early postoperative mobilization can be delayed due to postoperative orthostatic hypotension (POH) defined as a fall in systolic pressure > 20 mmHg and/or diastolic pressure > 10 mmHg or due to postoperative orthostatic intolerance (POI), characterized by dizziness, nausea, vomiting, blurred vision or syncope during mobilization. Although these conditions are well-known clinical problems that can delay early mobilization, relatively few data are available on pathophysiological mechanisms and possible treatments.
Several prospective studies with standardized mobilization procedures have already established that the incidence of POI and POH after THA is 38-42% at 6 hours after surgery.
Previous studies on patients undergoing prostatectomy and THA have also demonstrated that attenuated vasopressor response and a concomitant reduction in cardiac output (CO) and cerebral perfusion during postural changes after surgery contributes to POI and POH. Strategies aiming to reduce the incidence of POI and POH by pain management, vasoconstrictive treatment with alpha-1 receptor agonist, optimized fluid management with goal-directed fluid therapy and reduction of surgical stress-response with pre-operative high-dose glucocorticoid did not solve the problem.
The precise pathophysiological mechanisms of POI and POH remain to be elucidated and this is therefore the aim of the current prospective observational study.
Tarixlər
| Son Doğrulandı: | 12/31/2019 |
| İlk təqdim: | 11/27/2018 |
| Təxmini qeydiyyat təqdim edildi: | 11/27/2018 |
| İlk Göndərmə: | 11/29/2018 |
| Son Yeniləmə Göndərildi: | 01/26/2020 |
| Son Yeniləmə Göndərildi: | 01/27/2020 |
| Həqiqi Təhsilin Başlama Tarixi: | 03/17/2019 |
| Təxmini İlkin Tamamlanma Tarixi: | 12/31/2020 |
| Təxmini İşin Tamamlanma Tarixi: | 05/14/2021 |
Vəziyyət və ya xəstəlik
Faza
Qol Qrupları
| Qol | Müdaxilə / müalicə |
|---|---|
| Orthostatic intolerant (OI) Patients that experience symptoms of orthostatic intolerance (dizziness, nausea, vomiting, blurry vision or syncope) or orthostatic hypotension (fall in systolic pressure > 20 mmHg and/or diastolic pressure > 10 mmHg) during mobilisation | |
| Orthostatic tolerant (OT) Patients that do not experience symptoms of orthostatic intolerance (dizziness, nausea, vomiting, blurry vision or syncope) or orthostatic hypotension (fall in systolic pressure > 20 mmHg and/or diastolic pressure > 10 mmHg) during mobilisation |
Uyğunluq Kriteriyaları
| Təhsil üçün uyğun yaşlar | 18 Years Üçün 18 Years |
| Təhsilə Uyğun Cinslər | All |
| Nümunə götürmə metodu | Probability Sample |
| Sağlam Könüllüləri qəbul edir | Bəli |
| Kriteriyalar | Inclusion Criteria: - Age 18-65 - Written informed consent - Patients that speak and understand Danish - Patients undergoing primary unilateral total hip arthroplasty in spinal anesthesia in standardized fast-track setting Exclusion Criteria: - Alcohol and drug abuse - Cognitive dysfunction - History of orthostatic hypotension - Use of anxiolytic or antipsychotic drugs - Use of opioids - Use of following vasodilator antihypertensive drugs: beta-blockers, angiotensin converting enzyme inhibitors (ACEI), angiotensin 2 receptor blockers (ARBs), calcium channel blockers - Use of loop diuretics, thiazid diuretics and potassium-sparing diuretics - Use of Gabapentin - Arrhythmias or heart failure - Diabetes mellitus type I - Diabetes mellitus type II - History of following diseases in the autonomic nervous system: Parkinson disease, multiple sclerosis, autonomic neuropathies - History of cerebral apoplexy or transitory cerebral ischemia - Dementia - American Society of Anesthesiologists (ASA) score ≥ 4 |
Nəticə
İlkin nəticə tədbirləri
1. Incidence of orthostatic intolerance [6 hours postoperatively]
2. Incidence of orthostatic hypotension [6 hours postoperatively]
İkincili Nəticə Tədbirləri
1. Changes in systolic arterial pressure (SAP) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
2. Changes in diastolic arterial pressure (DAP) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
3. Changes in mean arterial pressure (MAP) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
4. Changes in systemic vascular resistance (SVR) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
5. Changes in cardiac output (CO) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
6. Changes in stroke volume (SV) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
7. Changes in heart rate variability (HRV) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
8. Changes in baroreflex sensitivity (BRS) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
9. Changes in peripheral perfusion index (PPI) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
10. Changes in cerebral perfusion (ScO2) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
11. Changes in muscular perfusion (SmO2) during mobilization [Preoperatively, 6 and 24 hours postoperatively]
12. Changes in total blood volume (TBV) [Preoperatively, 6 and 24 hours postoperatively]
13. Changes in erythrocyte volume (ECV) [Preoperatively, 6 and 24 hours postoperatively]
14. Changes in plasma volume (PV) [Preoperatively, 6 and 24 hours postoperatively]
15. Changes in hematocrit [Preoperatively, 6 and 24 hours postoperatively]
16. Changes in haemoglobin (Hgb) concentration [Preoperatively, 6 and 24 hours postoperatively]
17. Changes in C-Reactive Protein [Preoperatively, 6 and 24 hours postoperatively]
Digər nəticə tədbirləri
1. Pain score [Preoperatively, 6 and 24 hours postoperatively]
2. Estimated bleeding [Intraoperatively, 6 and 24 hours postoperatively]
3. Opioid use [6 and 24 hours postoperatively]
4. Cumulative fluid administration and losses [Intraoperatively, 6 and 24 hours postoperatively]
