Anesthesia, Hip Fractures, Pulmonary Complication
Conditions
Keywords
Hip fracture, delayed surgery, pulmonary complication, spinal anesthesia, general anesthesia
Brief summary
The objective of this study was to investigate the difference in postoperative pulmonary complications (PPCs) between spinal anesthesia and general anesthesia in patients undergoing delayed hip surgery.
Detailed description
In this study, the difference of 30 min arterial partial pressure of oxygen after operation was used as the main outcome index. By means of pulmonary ultrasound, pulmonary function monitoring and other physical and biochemical examinations, the difference of postoperative pulmonary complications between spinal anesthesia and general anesthesia in patients with delayed operation of hip fracture longer than 48 hours was compared.
Interventions
PROCEDUREspinal anesthesia
An intrathecal anesthetic technique.
PROCEDUREgeneral anesthesia
An intravenous (combined with inhalation) anesthetic technique.
Sponsors
Tongji Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients ≥ 65 years old * ASA Class I \ III * Surgical repair of femoral neck, intertrochanteric or subtrochanteric fractures * The time from diagnosis to surgery is more than 48 hours
Exclusion criteria
* Unable to walk about 3 meters or across a room without assistance before the fracture * Emergency surgery * Congestive heart failure, asthma, anemia (Hb \< 90 g/L), hypoalbuminemia (ALB \< 35g/L) * Abnormal coagulation function * Severe aortic stenosis * Injection site infection or increased intracranial pressure * Patients have participated in previous trials or have been determined by a surgeon or anesthesiologist to be unsuitable for randomization * The written informed consent of the patient or his/her representative cannot be obtained
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Arterial partial pressure of oxygen, PaO2 | 30 minutes after surgery | PaO2 was measured by arterial blood gas analysis |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Arterial partial pressure of oxygen, PaO2 | 30 minutes before surgery | PaO2 was measured by arterial blood gas analysis |
| Forced vital capacity, FVC | 30 minutes before surgery; 30 minutes after surgery; 24 hours after surgery | FVC was measured by Spirometer (SP70B) |
| Forced expiratory volume in 1 second, FEV1 | 30 minutes before surgery; 30 minutes after surgery; 24 hours after surgery | FEV1 was measured by Spirometer (SP70B) |
| Peak expiratory flow, PEF | 30 minutes before surgery; 30 minutes after surgery; 24 hours after surgery | PEF was measured by Spirometer (SP70B) |
| Lung Ultrasound Score (LUS) | 30 minutes before surgery, 30 minutes after surgery, 24 hours after surgery | Bedside measurements using portable ultrasound |
| Postoperative pulmonary complications | up to one month | Pulmonary complications (PPCs) include: (1) Evidence of pneumonia, pneumothorax, atelectasis and pleural effusion indicated by postoperative pulmonary ultrasound, chest film or chest CT; ② After surgery, the patient developed bronchospasm, ARDS, O2 requirement (nasal catheter or mask), non-invasive ventilation requirement, or unplanned endotracheal intubation/mechanical ventilation for more than 1 day; ③ The increase of inflammatory biochemical indexes 24 h after surgery suggested systemic inflammatory response (blood routine, C-reactive protein CRP, procalcitonin PCT and IL-6, IL-1β, TNF-α). |
| Hip mobility (Harris hip score, HHS) | up to one month | The Harris scale was used to score. Range:0-100. A total Harris hip score below 70 points was considered a poor result, 70 to 80 fair, 80 to 90 good, and 90 to 100 excellent. |
| PEF 25, 75, and 25-75 | 30 minutes before surgery; 30 minutes after surgery; 24 hours after surgery | PEF 25, 75, and 25-75 were measured by Spirometer (SP70B) |
Other
| Measure | Time frame | Description |
|---|---|---|
| Adverse outcomes | up to one month | Documented side effects associated with the intervention by an unwitting third party |
Countries
China
Contacts
Primary ContactTianzhu Liu, M.D.
Outcome results
None listed