Orthostatic Hypotension, Orthostatic Intolerance, Postoperative Complications
Conditions
Keywords
Orthostatic Intolerance, Orthostatic Hypotension, Knee arthroplasty
Brief summary
Incidence of Postoperative Orthostatic Intolerance and Postoperative Orthostatic Hypotension in Patients Undergoing Unilateral Total Knee Arthroplasty
Detailed description
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. Previous prospective studies of major surgery have reported that OI and OH are common problem during early postoperative mobilization, with a prevalence of 42-50%. Retrospective studies with a less-defined mobilization protocols have reported am OI prevalence in the range of 12-60 % across surgical procedures. The aim of our study is to determine the incidence of OI during early postoperative mobilization in fast track unilateral total knee arthroplasty.
Interventions
None listed
Sponsors
Kehlet, Henrik, M.D., Ph.D.
Hvidovre University Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
* Age ≥ 18 * Written informed consent * Patients that speak and understand Danish * Patients undergoing primary unilateral total knee arthroplasty in spinal anesthesia and standardized fast-track setting
Exclusion criteria
* Alcohol or drug abuse * Cognitive dysfunction * Known orthostatic hypotension * Use of anxiolytic drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of orthostatic intolerance | 6 hours postoperatively | Symptoms of orthostatic intolerance: dizziness, nausea, vomiting, blurry vision or syncope during mobilization |
| 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in mean arterial pressure (MAP) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg |
| Changes in systemic vascular resistance (SVR) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg⋅min⋅mL-1 |
| Changes in systolic arterial pressure (SAP) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg |
| Changes in stroke volume (SV) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mL |
| Changes in cardiac output (CO) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mL/min |
| Changes in diastolic arterial pressure (DAP) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg |
Countries
Denmark
Outcome results
None listed