Compression Stocking Use in Shoulder Arthroscopy in Beach Chair
キーワード
概要
説明
There have been numerous studies recently in the orthopaedic surgery and anesthesia literature related to both complications associated with arthroscopy in the BCP and ongoing efforts to improve patient safety. Advantages of this position when compared with the lateral decubitus position include easier anatomic orientation, lack of traction on the brachial plexus, ease of exam under anesthesia, and easier conversion to an open approach if needed. While extremely uncommon, complications such as ischemic brain and spinal cord injury as well as visual loss and ophthalmoplegia have been reported. A recent study reported that obesity increases the likelihood of having a CDE by as many as 12 times. CDEs were defined as intra-operative decreases in regional cerebral tissue oxygen saturation (rSO2) of 20% or greater from baseline as measured by near-infrared spectroscopy (NIRS). Since obesity is so common, it was decided to investigate a measure to potentially help decrease CDEs in this population.
The exact etiology of CDEs has not been definitively demonstrated and it is felt to be multifactorial. The sympathetic nervous system normally increases systemic vascular resistance and heart rate to maintain mean arterial blood pressure (MAP) when a person sits up or stands upright. This response is blunted by the vasodilatory effects of intravenous and inhaled anesthetics used in patients undergoing shoulder arthroscopy in the BCP. The result is decreased MAP and cerebral perfusion pressure that can contribute to hypoxic brain injury. The use of sequential compression devices placed on the legs of patients undergoing shoulder arthroscopy in the BCP has been shown to reduce the incidence of hypotension by increasing cardiac preload. This study excluded obese patients (BMI > 30) and did not directly monitor rSO2, but rather only monitored hemodynamic variables.
Compression stockings are often used in patients with venous insufficiency to help with pain and to control edema. The stockings compress the soft tissues and veins, and in conjunction with sequential compression devices (SCDs), may help to increase preload in an anesthetized patient in the BCP. To our knowledge, the effect of compression stockings on cerebral perfusion has not been studied. This study aims to determine if the use of compression stockings in obese patients undergoing shoulder arthroscopy in the BCP can decrease the incidence, frequency or magnitude of CDEs as measured by NIRS. We hypothesize that the use of compression stockings will result in decreased incidence and frequency of CDEs in our population.
日付
最終確認済み: | 07/31/2018 |
最初に提出された: | 11/21/2013 |
提出された推定登録数: | 11/21/2013 |
最初の投稿: | 11/26/2013 |
最終更新が送信されました: | 08/01/2018 |
最終更新日: | 08/30/2018 |
最初に提出された結果の日付: | 05/28/2014 |
最初に提出されたQC結果の日付: | 05/28/2014 |
最初に投稿された結果の日付: | 07/01/2014 |
実際の研究開始日: | 03/27/2013 |
一次完了予定日: | 07/26/2015 |
研究完了予定日: | 07/26/2015 |
状態または病気
介入/治療
Device: Prospective Case
段階
アームグループ
腕 | 介入/治療 |
---|---|
Experimental: Prospective Case Patients with a BMI of 30 kg/m^2 or greater who underwent shoulder arthroscopy in the beach chair position and were monitored intraoperatively using near-infrared spectroscopy while wearing thigh-high compression stockings. | Device: Prospective Case The intervention in this study are thigh-high compression stockings manufactured by Covidien. |
No Intervention: Historical Control Patients with a BMI of 30 kg/m^2 or greater who underwent elective shoulder arthroscopy in the beach-chair position and were monitored intraoperatively using near-infrared spectroscopy but without wearing compression stockings. |
適格基準
研究の対象となる年齢 | 18 Years に 18 Years |
研究に適格な性別 | All |
健康なボランティアを受け入れる | はい |
基準 | Inclusion Criteria: - Age 18 years or older - BMI greater than or equal to 30 kg/m^2 - Capable of receiving an interscalene nerve block. Exclusion Criteria: - Age < 18 - History of carotid artery stenosis equal to or greater than 90% - History of stroke - History of transient ischemic attack - History of syncope - History of vision loss |
結果
主な結果の測定
1. Cerebral Desaturation Event [Assessed intraoperatively, an average of 114 minutes]
二次的な結果の測定
1. Operation Time [End of surgery]