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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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| Published in: | Acta anaesthesiologica Scandinavica 2022-09, Vol.66 (8), p.934-943 |
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| container_title | Acta anaesthesiologica Scandinavica |
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| creator | Hristovska, Ana‐Marija Andersen, Louise B. Grentoft, Mette Mehlsen, Jesper Gromov, Kirill Kehlet, Henrik Foss, Nicolai B. |
| description | 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 |
| doi_str_mv | 10.1111/aas.14098 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2675604146</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2675604146</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2838-fa0ebff3eb04bb321c6c5b581fe52102506bb97e7fb8f8ab389bb8de4743274e3</originalsourceid><addsrcrecordid>eNp1kM9O3DAQhy1UBFvaAy-AIvXSHsL6X2yntxUqsBISB9qzZTtjNpDEqZ0Vyq2P0GfkSTAs9FCJuYxm5tOn0Q-hY4JPSa6lMemUcFyrPbQgrK5LUUnxAS0wxqSsiKSH6GNKd3lkvK4P0CGrhMKilgt0ex2nTUiTmVpXtMMUOohmcFAYP0EsvEnT45-_UzTuvrgfIO8zH8PY5cP8vVgPrm3ghR-aYgN9aObB9Nk1muwdN3NqQxdu509o35suwefXfoR-nf_4eXZZXl1frM9WV6WjiqnSGwzWewYWc2sZJU64ylaKeKgowbTCwtpagvRWeWUsU7W1qgEuOaOSAztCX3feMYbfW0iT7tvkoOvMAGGbNBWyEpgTLjL65T_0LmzjkL_TVGLKiRASZ-rbjnIxpBTB6zG2vYmzJlg_p69z-vol_cyevBq3tofmH_kWdwaWO-Ch7WB-36RXq5ud8glWGJEx</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2702416670</pqid></control><display><type>article</type><title>Orthostatic intolerance after fast‐track knee arthroplasty: Incidence and hemodynamic pathophysiology</title><source>Wiley</source><creator>Hristovska, Ana‐Marija ; Andersen, Louise B. ; Grentoft, Mette ; Mehlsen, Jesper ; Gromov, Kirill ; Kehlet, Henrik ; Foss, Nicolai B.</creator><creatorcontrib>Hristovska, Ana‐Marija ; Andersen, Louise B. ; Grentoft, Mette ; Mehlsen, Jesper ; Gromov, Kirill ; Kehlet, Henrik ; Foss, Nicolai B.</creatorcontrib><description>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 < .05), while severe OI patients demonstrated impaired diastolic, mean arterial pressures, heart rate, and cardiac output responses (all p < .05). No statistically significant differences in perioperative bleeding, fluid balance, surgery duration, postoperative hemoglobin, pain, or opioid use were observed between orthostatic tolerant and intolerant patients.
Conclusion
Early postoperative OI is common following fast‐track TKA. Pathophysiologic mechanisms include impaired orthostatic cardiovascular responses. The progression to severe OI symptoms appears to be primarily due to inadequate heart rate response.</description><identifier>ISSN: 0001-5172</identifier><identifier>EISSN: 1399-6576</identifier><identifier>DOI: 10.1111/aas.14098</identifier><identifier>PMID: 35680697</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>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</subject><ispartof>Acta anaesthesiologica Scandinavica, 2022-09, Vol.66 (8), p.934-943</ispartof><rights>2022 Acta Anaesthesiologica Scandinavica Foundation.</rights><rights>This article is protected by copyright. All rights reserved.</rights><rights>2022 The Acta Anaesthesiologica Scandinavica Foundation</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2838-fa0ebff3eb04bb321c6c5b581fe52102506bb97e7fb8f8ab389bb8de4743274e3</citedby><cites>FETCH-LOGICAL-c2838-fa0ebff3eb04bb321c6c5b581fe52102506bb97e7fb8f8ab389bb8de4743274e3</cites><orcidid>0000-0002-2209-1711</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35680697$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hristovska, Ana‐Marija</creatorcontrib><creatorcontrib>Andersen, Louise B.</creatorcontrib><creatorcontrib>Grentoft, Mette</creatorcontrib><creatorcontrib>Mehlsen, Jesper</creatorcontrib><creatorcontrib>Gromov, Kirill</creatorcontrib><creatorcontrib>Kehlet, Henrik</creatorcontrib><creatorcontrib>Foss, Nicolai B.</creatorcontrib><title>Orthostatic intolerance after fast‐track knee arthroplasty: Incidence and hemodynamic pathophysiology</title><title>Acta anaesthesiologica Scandinavica</title><addtitle>Acta Anaesthesiol Scand</addtitle><description>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 < .05), while severe OI patients demonstrated impaired diastolic, mean arterial pressures, heart rate, and cardiac output responses (all p < .05). No statistically significant differences in perioperative bleeding, fluid balance, surgery duration, postoperative hemoglobin, pain, or opioid use were observed between orthostatic tolerant and intolerant patients.
Conclusion
Early postoperative OI is common following fast‐track TKA. Pathophysiologic mechanisms include impaired orthostatic cardiovascular responses. The progression to severe OI symptoms appears to be primarily due to inadequate heart rate response.</description><subject>Analgesics</subject><subject>Anesthesia</subject><subject>Arthroplasty (knee)</subject><subject>Bleeding</subject><subject>Cardiac output</subject><subject>Cardiovascular system</subject><subject>Evaluation</subject><subject>Heart rate</subject><subject>Hemodynamics</subject><subject>Hemoglobin</subject><subject>Intolerance</subject><subject>Joint replacement surgery</subject><subject>Knee</subject><subject>Narcotics</subject><subject>Opioids</subject><subject>Orthostatic tolerance</subject><subject>Pain</subject><subject>Patients</subject><subject>Statistical analysis</subject><subject>Surgery</subject><issn>0001-5172</issn><issn>1399-6576</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp1kM9O3DAQhy1UBFvaAy-AIvXSHsL6X2yntxUqsBISB9qzZTtjNpDEqZ0Vyq2P0GfkSTAs9FCJuYxm5tOn0Q-hY4JPSa6lMemUcFyrPbQgrK5LUUnxAS0wxqSsiKSH6GNKd3lkvK4P0CGrhMKilgt0ex2nTUiTmVpXtMMUOohmcFAYP0EsvEnT45-_UzTuvrgfIO8zH8PY5cP8vVgPrm3ghR-aYgN9aObB9Nk1muwdN3NqQxdu509o35suwefXfoR-nf_4eXZZXl1frM9WV6WjiqnSGwzWewYWc2sZJU64ylaKeKgowbTCwtpagvRWeWUsU7W1qgEuOaOSAztCX3feMYbfW0iT7tvkoOvMAGGbNBWyEpgTLjL65T_0LmzjkL_TVGLKiRASZ-rbjnIxpBTB6zG2vYmzJlg_p69z-vol_cyevBq3tofmH_kWdwaWO-Ch7WB-36RXq5ud8glWGJEx</recordid><startdate>202209</startdate><enddate>202209</enddate><creator>Hristovska, Ana‐Marija</creator><creator>Andersen, Louise B.</creator><creator>Grentoft, Mette</creator><creator>Mehlsen, Jesper</creator><creator>Gromov, Kirill</creator><creator>Kehlet, Henrik</creator><creator>Foss, Nicolai B.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2209-1711</orcidid></search><sort><creationdate>202209</creationdate><title>Orthostatic intolerance after fast‐track knee arthroplasty: Incidence and hemodynamic pathophysiology</title><author>Hristovska, Ana‐Marija ; Andersen, Louise B. ; Grentoft, Mette ; Mehlsen, Jesper ; Gromov, Kirill ; Kehlet, Henrik ; Foss, Nicolai B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2838-fa0ebff3eb04bb321c6c5b581fe52102506bb97e7fb8f8ab389bb8de4743274e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Analgesics</topic><topic>Anesthesia</topic><topic>Arthroplasty (knee)</topic><topic>Bleeding</topic><topic>Cardiac output</topic><topic>Cardiovascular system</topic><topic>Evaluation</topic><topic>Heart rate</topic><topic>Hemodynamics</topic><topic>Hemoglobin</topic><topic>Intolerance</topic><topic>Joint replacement surgery</topic><topic>Knee</topic><topic>Narcotics</topic><topic>Opioids</topic><topic>Orthostatic tolerance</topic><topic>Pain</topic><topic>Patients</topic><topic>Statistical analysis</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hristovska, Ana‐Marija</creatorcontrib><creatorcontrib>Andersen, Louise B.</creatorcontrib><creatorcontrib>Grentoft, Mette</creatorcontrib><creatorcontrib>Mehlsen, Jesper</creatorcontrib><creatorcontrib>Gromov, Kirill</creatorcontrib><creatorcontrib>Kehlet, Henrik</creatorcontrib><creatorcontrib>Foss, Nicolai B.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Acta anaesthesiologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hristovska, Ana‐Marija</au><au>Andersen, Louise B.</au><au>Grentoft, Mette</au><au>Mehlsen, Jesper</au><au>Gromov, Kirill</au><au>Kehlet, Henrik</au><au>Foss, Nicolai B.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Orthostatic intolerance after fast‐track knee arthroplasty: Incidence and hemodynamic pathophysiology</atitle><jtitle>Acta anaesthesiologica Scandinavica</jtitle><addtitle>Acta Anaesthesiol Scand</addtitle><date>2022-09</date><risdate>2022</risdate><volume>66</volume><issue>8</issue><spage>934</spage><epage>943</epage><pages>934-943</pages><issn>0001-5172</issn><eissn>1399-6576</eissn><abstract>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 < .05), while severe OI patients demonstrated impaired diastolic, mean arterial pressures, heart rate, and cardiac output responses (all p < .05). No statistically significant differences in perioperative bleeding, fluid balance, surgery duration, postoperative hemoglobin, pain, or opioid use were observed between orthostatic tolerant and intolerant patients.
Conclusion
Early postoperative OI is common following fast‐track TKA. Pathophysiologic mechanisms include impaired orthostatic cardiovascular responses. The progression to severe OI symptoms appears to be primarily due to inadequate heart rate response.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>35680697</pmid><doi>10.1111/aas.14098</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2209-1711</orcidid></addata></record> |
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| ispartof | Acta anaesthesiologica Scandinavica, 2022-09, Vol.66 (8), p.934-943 |
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| 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 |
| title | Orthostatic intolerance after fast‐track knee arthroplasty: Incidence and hemodynamic pathophysiology |
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