Azerbaijani
Albanian
Arabic
Armenian
Azerbaijani
Belarusian
Bengali
Bosnian
Catalan
Czech
Danish
Deutsch
Dutch
English
Estonian
Finnish
Français
Greek
Haitian Creole
Hebrew
Hindi
Hungarian
Icelandic
Indonesian
Irish
Italian
Japanese
Korean
Latvian
Lithuanian
Macedonian
Mongolian
Norwegian
Persian
Polish
Portuguese
Romanian
Russian
Serbian
Slovak
Slovenian
Spanish
Swahili
Swedish
Turkish
Ukrainian
Vietnamese
Български
中文(简体)
中文(繁體)

Pathophysiologic Hemodynamics After Primary Unilateral Total Hip Arthroplasty (THA)

Yalnız qeydiyyatdan keçmiş istifadəçilər məqalələri tərcümə edə bilərlər
Giriş / Qeydiyyatdan keçin
Bağlantı panoya saxlanılır
Statusİşə qəbul
Sponsorlar
Hvidovre University Hospital
Əməkdaşlar
Henrik Kehlet

Açar sözlər

Mücərrəd

Incidence and pathophysiologic hemodynamics of orthostatic intolerance and orthostatic hypotension in patients undergoing unilateral THA

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

Orthostatic Intolerance
Orthostatic Hypotension
Postoperative Complications

Faza

-

Qol Qrupları

QolMüdaxilə / 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 CinslərAll
Nümunə götürmə metoduProbability Sample
Sağlam Könüllüləri qəbul edirBəli
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]

Symptoms of orthostatic intolerance: dizziness, nausea, vomiting, blurry vision or syncope during mobilization

2. Incidence of orthostatic hypotension [6 hours postoperatively]

Orthostatic hypotension is defined as a fall in systolic pressure > 20 mmHg and/or diastolic pressure > 10 mmHg during mobilization

İkincili Nəticə Tədbirləri

1. Changes in systolic arterial pressure (SAP) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in mmHg

2. Changes in diastolic arterial pressure (DAP) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in mmHg

3. Changes in mean arterial pressure (MAP) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in mmHg

4. Changes in systemic vascular resistance (SVR) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in mmHg⋅min⋅mL-1

5. Changes in cardiac output (CO) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in mL/min

6. Changes in stroke volume (SV) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in mL

7. Changes in heart rate variability (HRV) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in ms

8. Changes in baroreflex sensitivity (BRS) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in ms/mmHg

9. Changes in peripheral perfusion index (PPI) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in arbitrary units (AU)

10. Changes in cerebral perfusion (ScO2) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in %

11. Changes in muscular perfusion (SmO2) during mobilization [Preoperatively, 6 and 24 hours postoperatively]

Measured in %

12. Changes in total blood volume (TBV) [Preoperatively, 6 and 24 hours postoperatively]

Measured in mL

13. Changes in erythrocyte volume (ECV) [Preoperatively, 6 and 24 hours postoperatively]

Measured in mL

14. Changes in plasma volume (PV) [Preoperatively, 6 and 24 hours postoperatively]

Measured in mL

15. Changes in hematocrit [Preoperatively, 6 and 24 hours postoperatively]

Measured in %

16. Changes in haemoglobin (Hgb) concentration [Preoperatively, 6 and 24 hours postoperatively]

Measured in millimoles/L

17. Changes in C-Reactive Protein [Preoperatively, 6 and 24 hours postoperatively]

Measured in mg/L

Digər nəticə tədbirləri

1. Pain score [Preoperatively, 6 and 24 hours postoperatively]

Measured by verbal rating scale (VRS) from 0 to 10 (0 = no pain, 10 = worse pain imaginable)

2. Estimated bleeding [Intraoperatively, 6 and 24 hours postoperatively]

Measured in mL

3. Opioid use [6 and 24 hours postoperatively]

Measured in mg

4. Cumulative fluid administration and losses [Intraoperatively, 6 and 24 hours postoperatively]

Measured in mg

Facebook səhifəmizə qoşulun

Elm tərəfindən dəstəklənən ən tam dərman bitkiləri bazası

  • 55 dildə işləyir
  • Elm tərəfindən dəstəklənən bitki mənşəli müalicələr
  • Təsvirə görə otların tanınması
  • İnteraktiv GPS xəritəsi - yerdəki otları etiketləyin (tezliklə)
  • Axtarışınızla əlaqəli elmi nəşrləri oxuyun
  • Təsirlərinə görə dərman bitkilərini axtarın
  • Maraqlarınızı təşkil edin və xəbər araşdırmaları, klinik sınaqlar və patentlər barədə məlumatlı olun

Bir simptom və ya bir xəstəlik yazın və kömək edə biləcək otlar haqqında oxuyun, bir ot yazın və istifadə olunan xəstəliklərə və simptomlara baxın.
* Bütün məlumatlar dərc olunmuş elmi araşdırmalara əsaslanır

Google Play badgeApp Store badge