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| Name | Class |
|---|---|
| Kehlet, Henrik, M.D., Ph.D. | INDIV |
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Incidence and pathophysiologic hemodynamics of orthostatic intolerance and orthostatic hypotension in patients undergoing UKA
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.
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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 mobilization |
| |
| 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 mobilization |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Standardized mobilization procedure | Other | 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) |
| 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, LiDCO-apparatus | Preoperatively, 6 and 24 hours postoperatively |
| Changes in diastolic arterial pressure (DAP) during mobilization |
| Measure | Description | Time Frame |
|---|---|---|
| Pain score during mobilization | Measured by verbal rating scale (VRS) from 0 to 10 | Preoperatively, 6 and 24 hours postoperatively |
| Estimated bleeding | Measured in mL |
Inclusion Criteria:
Exclusion Criteria:
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Patients were screened in the electronic patient system, and were first screened for inclusion criteria, and afterwards exclusion criteria.
Patients were eligible to enroll in the study if they were >18 years, spoke and understood Danish, signed an informed consent formula and underwent UKA in spinal anesthesia at Hvidovre Hospital. They were excluded if they had 1) pre-existing orthostatic hypotension or intolerance, 2) Alcohol or substance abuse, 3) everyday treatment with either anxiolytic or antipsychotic medicine 4) Cognitive dysfunction. 5) Or if surgery was converted to general anesthesia or total knee arthroplasty.
| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Louise Bundsgaard Andersen, medical student | Contact | +45 41161599 | louise.bundsgaard.andersen.01@regionh.dk | |
| Ana-Marija Hristovska, MD | Contact | +4538621508 | ana-marija.hristovska.02@regionh.dk |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hvidovre Hospital | Recruiting | Hvidovre | 2650 | Denmark |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38561817 | Derived | Hristovska AM, Andersen LB, Uldall-Hansen B, Kehlet H, Troelsen A, Gromov K, Foss NB. Postoperative orthostatic intolerance following fast-track unicompartmental knee arthroplasty: incidence and hemodynamics-a prospective observational cohort study. J Orthop Surg Res. 2024 Apr 1;19(1):214. doi: 10.1186/s13018-024-04639-6. |
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|
Measured in mmHg, LiDCO-apparatus
| Preoperatively, 6 and 24 hours postoperatively |
| Changes in mean arterial pressure (MAP) during mobilization | Measured in mmHg, LiDCO-apparatus | Preoperatively, 6 and 24 hours postoperatively |
| Changes in cardiac output (CO) during mobilization | Measured in mL/min, LiDCO-apparatus | 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 stroke volume (SV) during mobilization | Measured in mL, LiDCO-apparatus | Preoperatively, 6 and 24 hours postoperatively |
| Changes in heart rate variability (HRV) during mobilization | Measured in ms, LiDCO-apparatus | Preoperatively, 6 and 24 hours postoperatively |
| Changes in peripheral perfusion index (PPI) during mobilization | Measured in arbitrary units (AU), Massimo apparatus | Preoperatively, 6 and 24 hours postoperatively |
| Changes in cerebral perfusion (ScO2) during mobilization | Measured in %, NIRS-apparatus | Preoperatively, 6 and 24 hours postoperatively |
| Changes in muscular perfusion (SmO2) during mobilization | Measured in %, NIRS-apparatus | Preoperatively, 6 and 24 hours postoperatively |
| Changes in haemoglobin (Hgb) concentration | Measured in millimoles/L | Preoperatively, 6 and 24 hours postoperatively |
| Changes in C-Reactive Protein | Measured in mg/L | Preoperatively, 6 and 24 hours postoperatively |
| Preoperatively, 6 and 24 hours postoperatively |
| Opioid usage | Measured in mg | Preoperatively, 6 and 24 hours postoperatively |
| Cumulative fluid administration and losses | Measured in mL | Preoperatively, 6 and 24 hours postoperatively |
| ID | Term |
|---|---|
| D007024 | Hypotension, Orthostatic |
| D054971 | Orthostatic Intolerance |
| D011183 | Postoperative Complications |
| ID | Term |
|---|---|
| D054969 | Primary Dysautonomias |
| D001342 | Autonomic Nervous System Diseases |
| D009422 | Nervous System Diseases |
| D007022 | Hypotension |
| D014652 | Vascular Diseases |
| D002318 | Cardiovascular Diseases |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010335 | Pathologic Processes |
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