Orthostatic Hypotension, Orthostatic Intolerance, Postoperative Complications
Conditions
Brief summary
Incidence and pathophysiologic hemodynamics of orthostatic intolerance and orthostatic hypotension in patients undergoing UKA
Detailed description
In today's multimodal fast-track perioperative care program (ERAS) early mobilization is an essential cornerstone, and is known to prevent postoperative morbidity and lower length of stay in the hospital. Intact orthostatic blood pressure regulation is necessary to complete mobilization, and postoperative orthostatic hypotension (OH), defined as a drop in systolic arterial pressure (SAP) \> 20 mmHg or a drop \>10 mmHg in diastolic arterial pressure (DAP) and orthostatic intolerance (OI), characterized by dizziness, nausea, feeling warm and syncope related to orthostatic challenge, are well-known reasons for delayed early mobilization, prolonged bedrest and delayed ambulation. Former studies have been accessing the postoperative incidence in THA-patients (22%-40%), TKA-patients(36%), colorectal patients(53%), abdominal and cardiothoracic surgery patients(40%), radical prostatectomy patients (50%). One study have been accessing the postoperative incidence of OI in mastectomy patients and found an incidence of 4%, and thereby indicating that postoperative OI is not an issue in minor surgery. This study is the first, to our acknowledgement, which accesses the postoperative incidence of OI/OH in UKA-patients.
Interventions
OTHERStandardized mobilization procedure
5 minutes bed rest (h1), followed by 3 minutes passive leg raise (PLR), followed by 5 minutes bed rest (h2), followed by 3 minutes sitting on the egde of the bed (sit), followed by 3 minutes standing/walking on the spot (sta), followed by 5 minutes bedrest (h3)
Sponsors
Kehlet, Henrik, M.D., Ph.D.
Copenhagen University Hospital, Hvidovre
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \>18 years and * Patients undergoing UKA in spinal anesthesia at Hvidovre Hospital in a standardized fast-track setting. * Patients that speak and understand Danish * Written informed consent
Exclusion criteria
* Pre-existing orthostatic hypotension or intolerance * Alcohol or substance abuse * everyday treatment with either anxiolytic or antipsychotic medicine * Cognitive dysfunction * If surgery was converted to general anesthesia or total knee arthroplasty.
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 systemic vascular resistance (SVR) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg⋅min⋅mL-1 |
| Changes in cerebral perfusion (ScO2) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in %, NIRS-apparatus |
| Changes in muscular perfusion (SmO2) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in %, NIRS-apparatus |
| Changes in haemoglobin (Hgb) concentration | Preoperatively, 6 and 24 hours postoperatively | Measured in millimoles/L |
| Changes in C-Reactive Protein | Preoperatively, 6 and 24 hours postoperatively | Measured in mg/L |
| Changes in stroke volume (SV) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mL, LiDCO-apparatus |
| Changes in systolic arterial pressure (SAP) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg, LiDCO-apparatus |
| Changes in diastolic arterial pressure (DAP) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg, LiDCO-apparatus |
| Changes in mean arterial pressure (MAP) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mmHg, LiDCO-apparatus |
| Changes in cardiac output (CO) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in mL/min, LiDCO-apparatus |
| Changes in heart rate variability (HRV) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in ms, LiDCO-apparatus |
| Changes in peripheral perfusion index (PPI) during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured in arbitrary units (AU), Massimo apparatus |
Other
| Measure | Time frame | Description |
|---|---|---|
| Cumulative fluid administration and losses | Preoperatively, 6 and 24 hours postoperatively | Measured in mL |
| Opioid usage | Preoperatively, 6 and 24 hours postoperatively | Measured in mg |
| Estimated bleeding | Preoperatively, 6 and 24 hours postoperatively | Measured in mL |
| Pain score during mobilization | Preoperatively, 6 and 24 hours postoperatively | Measured by verbal rating scale (VRS) from 0 to 10 |
Countries
Denmark
Contacts
Primary ContactLouise Bundsgaard Andersen, medical student
Backup ContactAna-Marija Hristovska, MD
Outcome results
None listed