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| Name | Class |
|---|---|
| Kehlet, Henrik, M.D., Ph.D. | INDIV |
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Incidence of Postoperative Orthostatic Intolerance and Postoperative Orthostatic Hypotension in Patients Undergoing Unilateral Total Knee Arthroplasty
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.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Orthostatic intolerant (OI) | Patients that experience symptoms of orthostatic intolerance (dizziness, nausea, vomiting, blurry vision or syncope) or orthostatic hypotension (fall in systolic pressure > 20 mmHg and/or diastolic pressure > 10 mmHg) during mobilisation | ||
| Orthostatic tolerant (OT) | Patients that do not experience symptoms of orthostatic intolerance (dizziness, nausea, vomiting, blurry vision or syncope) or orthostatic hypotension (fall in systolic pressure > 20 mmHg and/or diastolic pressure > 10 mmHg) during mobilisation |
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| Measure | Description | Time Frame |
|---|---|---|
| Incidence of orthostatic intolerance | Symptoms of orthostatic intolerance: dizziness, nausea, vomiting, blurry vision or syncope during mobilization | 6 hours postoperatively |
| Incidence of orthostatic hypotension | Orthostatic hypotension is defined as a fall in systolic pressure > 20 mmHg and/or diastolic pressure > 10 mmHg during mobilization | 6 hours postoperatively |
| Measure | Description | Time Frame |
|---|---|---|
| Changes in systolic arterial pressure (SAP) during mobilization | Measured in mmHg | Preoperatively, 6 and 24 hours postoperatively |
| Changes in diastolic arterial pressure (DAP) during mobilization |
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Inclusion Criteria:
Exclusion Criteria:
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Patients undergoing primary unilateral total knee arthroplasty in spinal anesthesia and standardized fast-track setting
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| Name | Affiliation | Role |
|---|---|---|
| Ana-Marija Hristovska, MD | Department of Anesthesiology, Hvidovre Hospital, Copenhagen | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hvidovre University Hosptial | Copenhagen | Denmark |
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| ID | Term |
|---|---|
| D054971 | Orthostatic Intolerance |
| D007024 | Hypotension, Orthostatic |
| D011183 | Postoperative Complications |
| ID | Term |
|---|---|
| D054969 | Primary Dysautonomias |
| D001342 | Autonomic Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D009461 | Neurologic Manifestations |
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Measured in mmHg
| Preoperatively, 6 and 24 hours postoperatively |
| Changes in mean arterial pressure (MAP) during mobilization | Measured in mmHg | Preoperatively, 6 and 24 hours postoperatively |
| Changes in systemic vascular resistance (SVR) during mobilization | Measured in mmHg⋅min⋅mL-1 | Preoperatively, 6 and 24 hours postoperatively |
| Changes in cardiac output (CO) during mobilization | Measured in mL/min | Preoperatively, 6 and 24 hours postoperatively |
| Changes in stroke volume (SV) during mobilization | Measured in mL | Preoperatively, 6 and 24 hours postoperatively |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D007022 | Hypotension |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D010335 | Pathologic Processes |