Orthostatic intolerance after fast‐track knee arthroplasty: Incidence and hemodynamic pathophysiology

Background Early postoperative mobilization can be hindered by orthostatic intolerance (OI) due to failed orthostatic cardiovascular regulation. The underlying mechanisms are not fully understood and specific data after total knee arthroplasty (TKA) are lacking. Therefore, we evaluated the incidence...

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Bibliographic Details
Published in:Acta anaesthesiologica Scandinavica 2022-09, Vol.66 (8), p.934-943
Main Authors: Hristovska, Ana‐Marija, Andersen, Louise B., Grentoft, Mette, Mehlsen, Jesper, Gromov, Kirill, Kehlet, Henrik, Foss, Nicolai B.
Format: Article
Language:English
Subjects:
Analgesics
Anesthesia
Arthroplasty (knee)
Bleeding
Cardiac output
Cardiovascular system
Evaluation
Heart rate
Hemodynamics
Hemoglobin
Intolerance
Joint replacement surgery
Knee
Narcotics
Opioids
Orthostatic tolerance
Pain
Patients
Statistical analysis
Surgery
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Summary:Background Early postoperative mobilization can be hindered by orthostatic intolerance (OI) due to failed orthostatic cardiovascular regulation. The underlying mechanisms are not fully understood and specific data after total knee arthroplasty (TKA) are lacking. Therefore, we evaluated the incidence of OI and the cardiovascular response to mobilization in fast‐track TKA. Methods This prospective observational cohort study included 45 patients scheduled for primary TKA in spinal anesthesia with a multimodal opioid‐sparing analgesic regime. OI and the cardiovascular response to sitting and standing were evaluated with a standardized mobilization procedure preoperatively, and at 6 and 24 h postoperatively. Hemodynamic variables were measured non‐invasively (LiDCO™ Rapid). Perioperative bleeding, fluid balance, surgery duration, postoperative hemoglobin, opioid use, and pain during mobilization were recorded. Results Eighteen (44%) and 8 (22%) patients demonstrated OI at 6 and 24 h after surgery, respectively. Four (10%) and 2 (5%) patients experienced severe OI and terminated the mobilization procedure prematurely. Dizziness was the most common OI symptom during mobilization at 6 h. OI was associated with decreased orthostatic responses in systolic, diastolic, mean arterial pressures, and heart rate (all p 
ISSN:0001-5172
1399-6576
DOI:10.1111/aas.14098