Myocardial Ischaemia
Conditions
Brief summary
Comparison of the effect of two anaesthesia methods in preventing perioperative myocardial infarction in patients with cardiac risk undergoing total knee arthroplasty
Detailed description
we enrolled 50 patients of both sex of American society of Anesthesiologists (ASA) physical status II where the presence and/or risk for coronary artery disease (CAD) as well as planned lower extremity surgery was considered. Presence of CAD was ascertained by history of myocardial infarction and diagnosis of typical angina or atypical angina with a positive stress test & ECG finding. Risk for CAD included age (\> 65 years old), hypertension, smoking habit, blood cholesterol (\>240 mg/dL), and diabetes. who met the selection criteria were randomly allocated to 1 of the 2 groups (25 patients) each: * Group (G): received general anaesthesia followed by IV patient-controlled analgesia (IV PCA). * Group (F): received spinal anaesthesia followed by continuous ultrasound guided femoral never block once the anaesthesia-induced motor block resolved. We aimed to compare the effect of the two anaesthesia methods in preventing perioperative myocardial infarction in patients with cardiac risk undergoing total knee arthroplasty. The primary outcome included perioperative levels of brain natriuretic peptide & cardiac troponins. Secondary outcomes included postoperative operative pain assessment using visual analogue scale, total amount of analgesic consumption, patient satisfaction & cardiovascular complications (myocardial infarction, arrhythmias , heart failure, hypotension, hypertension & the need for inotropic agents).
Interventions
PROCEDUREgeneral anaesthesia
intraoperative general anaesthesia followed by postoperative IV patient analgesia
PROCEDUREspinal anaesthesia
patient received spinal followed by continuous ultrasound guided femoral never block.
Sponsors
Alexandria University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Intervention model description
The aim of this study is to compare the effect of two anaesthesia methods in preventing perioperative myocardial infarction in patients with cardiac risk undergoing total knee arthroplasty. The primary outcome included perioperative levels of brain natriuretic peptide & cardiac troponins. Secondary outcomes included postoperative operative pain assessment using visual analogue scale, total amount of analgesic consumption, patient satisfaction & cardiovascular complications (myocardial infarction, arrhythmias , heart failure, hypotension, hypertension & the need for inotropic agents ).
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* presence and/or risk for coronary artery disease (CAD) as well as planned lower extremity surgery was considered. Presence of CAD was ascertained by history of myocardial infarction and diagnosis of typical angina or atypical angina with a positive stress test & ECG finding. Risk for CAD included age (\> 65 years old), hypertension, smoking habit, blood cholesterol (\>240 mg/dL), and diabetes.
Exclusion criteria
* 1\) severe impairment of left ventricular function (ejection fraction \< 40 %). 2) renal failure requiring hemodialysis. 3) known allergies to the drugs used in the present study. 4) contraindications to regional blocks (localized infection, and use of an antiplatelet drug within 3 days before the surgery). 5) unusual blood coagulation tests.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| brain natriuretic peptide | immediately preoperatively | marker for myocardial infarction |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| visual analogue scale | after 6 hour postoperatively | a score to evaluate postoperative pain intensity |
| amount of analgesic consumption | after 48 hour postoperatively | the total amount of analgesic consumed by each patient |
Countries
Egypt
Outcome results
None listed