Safety of epidural combined with small-dose intravenous anesthesia during total knee arthroplasty in elderly patients with hypertension

Transcription

1 Chinese Journal of Tissue Engineering Research August 27, 2015 Vol.19, No ( ) min 10 min ( ) 10 min 10 min (P < 0.05) (P < 0.05) 3 15 (P < 0.05) :R318 :A : (2015) [J] (35): doi: /j.issn Safety of epidural combined with small-dose intravenous anesthesia during total knee arthroplasty in elderly patients with hypertension Zhang Wei-qiang 1, Xu Guan-jie 2, Yang Li-xin 3, Li Tong-hua 3, Zhang Xiao-lin 4, Zhang Wen-jing 5 ( 1 Department of Anesthesiology, Lincheng County People s Hospital, Xingtai , Hebei Province, China; 2 Department of Anesthesiology, the Third Hospital of Hebei Medical University, Shijiazhuang , Hebei Province, China; 3 Department of Orthopedics, Lincheng County People s Hospital, Xingtai , Hebei Province, China; 4 Department of General Surgery, Xingtai County People s Hospital, Xingtai , Hebei Province, China; 5 Department of Infection Control, Lincheng County People s Hospital, Xingtai , Hebei Province, China) Abstract BACKGROUND: Elderly hypertensive patients often associated with organ and tissue ischemia. All kinds of risks are easy to appear in the process of undergoing arthroplasty. To ensure the smooth operation and to improve the safety of the surgery treatment, it is needed to choose an appropriate mode of anesthesia. OBJECTIVE: To explore the application security of epidural combined with small dose of intravenous anesthesia in total knee arthroplasty in elderly hypertensive patients. Zhang Wei-qiang, Attending physician, Department of Anesthesiology, Lincheng County People s Hospital, Xingtai , Hebei Province, China Corresponding author: Zhang Wei-qiang, Department of Anesthesiology, Lincheng County People s Hospital, Xingtai , Hebei Province, China Accepted: ISSN CN /R CODEN: ZLKHAH 5615

2 . METHODS: A total of 64 elderly hypertensive patients with arthroplasty in the Third Hospital of Hebei Medical University from December 2013 to December 2014 were selected and were divided into control group (32 cases) and observation group (32 cases). They were given total intravenous anesthesia and epidural block combined with small dose of intravenous anesthesia. Systolic blood pressure, diastolic blood pressure, heart rate, blood oxygen saturation and changes in respiratory rate were detected before anesthesia, after anesthesia induction, 10 minutes after anesthesia, 10 minutes after use of bone cement, and at the end of arthroplasty in both groups. The usage of vasoactive drugs (including ephedrine and dopamine) during arthroplasty and adverse events after arthroplasty were recorded. RESULTS AND CONCLUSION: Compared with pre-anesthesia, systolic blood pressure and diastolic blood pressure were significantly reduced and blood oxygen saturation was increased at 10 minutes after anesthesia and 10 minutes after the application of bone cement in both groups (P < 0.05). In the end of arthroplasty, systolic blood pressure, diastolic blood pressure and respiratory rate were significantly higher in the control group than in the observation group (P < 0.05). A total of 3 cases in the observation group and 15 cases in the control group used vasoactive drugs (including ephedrine and dopamine), and there was a significant difference in its usage (P < 0.05). Moreover, five patients in the control group experienced respiratory insufficiency, which was apparently improved after given the short-term ventilator support. These results confirm that compared with the total intravenous anesthesia, epidural block combined with small dose of intravenous anesthesia showed a high safety during total knee arthroplasty in elderly hypertensive patients. Subject headings: Arthroplasty, Replacement, Knee; Hypertension; Anesthesia, Epidural; Anesthesia, General Zhang WQ, Xu GJ, Yang LX, Li TH, Zhang XL, Zhang WJ. Safety of epidural combined with small-dose intravenous anesthesia during total knee arthroplasty in elderly patients with hypertension. Zhongguo Zuzhi Gongcheng Yanjiu. 2015;19(35): Introduction [1] [2] [3] [4-5], [6-7] 64 1Subjects and methods (74.15±7.69) () YZB/USA ( PFC Sigma TC3) Ti6Al4V Ti6Al4V 5616 P.O. Box 10002, Shenyang

3 . 0.5 h0.1 g 500 ml 6% mg/kg3 µg/kg 0.2 mg/kg mg/kg 6 8 ml/kg mg/kg µg/(kg min) 30% L 2 L ml 1% +0.5% mg/kg mg 10 min 10 min ( ) SPSS 17.0 t 2 P < Results (P > 0.05) min 10 min (P < 0.05) Figure 1 Flowchart in patients of both groups 1 (x _ ±s n=32) Table 1 Comparison of baseline data in patients of both groups ( ) (kg) (cm) (cm 2 ) 73.12± ± ± ± ± ± ± ±0.12 P > 0.05 > 0.05 > 0.05 > (x _ ±s n=32) Table 2 Comparison of systolic blood pressure, diastolic blood pressure, heart rate, blood oxygen saturation and respiratory rate in patients of both groups (mm Hg) (mm Hg) ( /min) (%) ( /min) 168±18 74±15 76± ± ± ±20 a 63±17 78± ± ± min 147±26 a 64±15 a 69±7 99.2±3.5 a 16.0± min 148±25 a 65±8 a 68±9 98.9±3.8 a 16.2± ±27 67±6 83± ± ± ±19 74±15 79± ± ± ±29 ab 60±18 79± ± ± min 154±23 a 62±11 a 70±8 99.1±2.6 a 13.0± min 149±22 64±9 a 82± ±1.3 a 13.1± ±21 b 110±13 b 86± ± ±4.9 b a P < 0.05 b P < mm Hg=0.133 kpa (P < 0.05) (P < 0.05) 5 3Discussion [8] [9] ISSN CN /R CODEN: ZLKHAH 5617

4 . [10-11] [12] [13-16] [17-18] [19-20] [21-23] [24-25] [26-28] [29] [30] [31-32] [33] min 10 min 10 min 315 6% 5 P.O. Box 10002, Shenyang

5 . 4 References [1],,, [J].,2006,35(2): [2],,,. [J].,2009,49(23): [3],,,. [J].,2014, 39(3): [4],,,. [J].,2008,30(8): [5],,,. [J].,2009,35(9): [6],,,. [J].,2013, 33(14): [7] Paxton EW, Inacio MC, Khatod M, et al. Kaiser Permanente National Total Joint Replacement Registry: Aligning Operations With Information Technology. Clin Orthop Relat Res.2010;468 (10): [8],,,. [J].,2013,36(2): [9],. [J].,2013,24(10): [10],,,.Supreme [J].,2014,30(6): [11],,,. - [J].,2006,27(11): [12],. [J].,2014,34(20): [13] Tay Swee Cheng R, Klainin-Yobas P, Hegney D, et al. Factors relating to perioperative experience of older persons undergoing joint replacement surgery: an integrative literature review.disabil Rehabil. 2014;37(1):9-24. [14] Cabrita HA, de Godoy Santos AL, Gomes Gobbi RG. Necrose avascular da cabeça femoral em pacientes HIV positivos: resultados iniciais do tratamento cirúrgico por substituição articular cerâmica-cerâmica/ Avascular necrosis of the femoral head in HIV-infected patients: preliminary results from surgical treatment for ceramic-ceramic joint replacement. Rev Bras Ortop. 2012;47(5): [15],.15 [J]., 2004,44(35): [16]. [J].,2013,26(30): [17],,,. [J].,2010,32(3): [18],,,. [J]., 2009,25(6): [19] Hills AJ, Ahmed N, Matthews NS. Concurrent Bilateral Total Temporomandibular Joint Replacement Surgery and Conventional Maxillary Osteotomy Utilizing Virtual Surgical Planning Web-Based Technology. J Craniofac Surg. 2014; 25(3): [20]. [J]., 2008,15(z1):52. [21],,,.( ) [J].,2012,7(1): [22],. [J].( ),2011,40(8): [23],,,. [J].,2014,35(29): [24],. [J].,2014,35(8): , 143. [25] Emin A, Andreas B, Lukas S. Simultaneous bilateral hip replacement reveals superior outcome and fewer complications than two-stage procedures: a prospective study including 1819 patients and 5801 follow-ups from a total joint replacement registry. BMC Musculoskelet Disord. 2010;11(1): 245. [26],,,. [J].,2013,10(18): ,2499. [27],,,. 30 [J].,2014,33(9): [28]. [J].,2010,27(11): [29] Wylde V, Gooberman-Hill R, Horwood J, et al. The effect of local anaesthetic wound infiltration on chronic pain after lower limb joint replacement: A protocol for a double-blind randomised controlled trial. BMC Musculoskelet Disord. 2011; 12(1):53. [30],,,. [J].(), 2012,29(4): [31].0.5%ASA - 120[J]., 2013, 8(5):244. [32],,,. Logistic [J]., 2010,14(17): [33] Lester LE, Bevins JW, Hughes C. Range of motion of the metacarpophalangeal joint in rheumatoid patients, with and without a flexible joint replacement prosthesis, compared with normal subjects. Clin Biomech. 2012;27(5): ISSN CN /R CODEN: ZLKHAH 5619