Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study
Introduction: Total Knee Arthroplasty (TKA) is a routinely used procedure for the management of knee osteoarthritis. Various haemodynamic changes can occur during TKA, especially during cementing and tourniquet deflation, which can have a significant impact on the patient’s clinical condition. T...
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| Format: | Article |
| Language: | English |
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JCDR Research and Publications Private Limited
2023-10-01
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| Series: | Journal of Clinical and Diagnostic Research |
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| Online Access: | https://jcdr.net/articles/PDF/18511/60559_CE[Ra1]_F(KR)_QC(SHK_IS)_PF1(AG_OM)_PFA(AG_KM)_PN(KM).pdf |
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| author | Manju Bala Susheela Taxak Paras Bajaj Monica Chhikara Mangal Ahlawat Ashwini Zokarkar |
| author_facet | Manju Bala Susheela Taxak Paras Bajaj Monica Chhikara Mangal Ahlawat Ashwini Zokarkar |
| author_sort | Manju Bala |
| collection | DOAJ |
| description | Introduction: Total Knee Arthroplasty (TKA) is a routinely used
procedure for the management of knee osteoarthritis. Various
haemodynamic changes can occur during TKA, especially
during cementing and tourniquet deflation, which can have a
significant impact on the patient’s clinical condition. This study
emphasises the importance of close haemodynamic monitoring
for the timely detection of potential complications during this
procedure.
Aim: To evaluate the haemodynamic changes occurring during
spinal anaesthesia, bone cementation, and tourniquet deflation
using Transthoracic Echocardiography (TTE) along with routine
non invasive haemodynamic monitors in patients undergoing
TKA.
Materials and Methods: The present study was a prospective,
observational single-arm study conducted at a tertiary care
centre from February 2019 to March 202.Thirty patients of
either sex, belonging to American Society of Anaesthesiologists
physical status I (aged between 40-70 years) and scheduled
for TKA under regional anaesthesia, were enrolled in the study.
Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood
Pressure (DBP), SpO2
levels, respiratory rate, and End-Tidal
CO2
(EtCO2
) were recorded at various time intervals, including
baseline value, after spinal anaesthesia, before cement
implantation, after cement implantation, before tourniquet
deflation, after tourniquet deflation, and at the end of the surgery.
Blood gas analysis and TTE were recorded preoperatively, five
minutes after cementation, and five minutes after tourniquet
deflation. Data were collected and analysed using Student’s
t-test for continuous variables and Chi-square test or Fisher’s
exact test for nominal categorical variables. Statistical analysis
was performed using the SPSS statistical package (version
SPSS 17.0).
Results: The mean age, weight, and height of the patients
were 54.46±6.78 years, 66.43±5.31 kg, and 152.5±7.71 cm,
respectively. The mean HR increased from 82.27±6.11 beats/
minute to 101.43±5.23 and 104.33+4.70 beats/minute after
three and six minutes of cementation (p-value=0.001). The
mean SBP increased from 121.67 mmHg to 144.13 mmHg
and 138.87 mmHg after three and six minutes of cementation
(p-value=0.001). The preoperative mean pH was 7.44, which
decreased to 7.39 at five minutes after cement implantation and
7.38 after five minutes of tourniquet deflation (p-value=0.001).
The preoperative mean PaCO2
value was 44.83 mmHg,
which increased to 62.30 mmHg after five minutes of cement
implantation and 55.17 mmHg after five minutes of tourniquet
deflation (p-value<0.05).
Conclusion: There was a significant increase in HR, blood
pressure, and PaCO2
, as well as a decrease in pH after bone
cement implantation. However, TTE performed at various time
points did not suggest any significant changes during TKA.
Hence, this study demonstrates that routine haemodynamic
monitoring is sufficient, and no additional monitoring like ECHO
is required in ASA 1 patients undergoing TKA. |
| first_indexed | 2024-03-11T17:00:11Z |
| format | Article |
| id | doaj.art-48634e3947764de9894dbd9f75ab8879 |
| institution | Directory Open Access Journal |
| issn | 2249-782X 0973-709X |
| language | English |
| last_indexed | 2024-03-11T17:00:11Z |
| publishDate | 2023-10-01 |
| publisher | JCDR Research and Publications Private Limited |
| record_format | Article |
| series | Journal of Clinical and Diagnostic Research |
| spelling | doaj.art-48634e3947764de9894dbd9f75ab88792023-10-20T10:19:13ZengJCDR Research and Publications Private LimitedJournal of Clinical and Diagnostic Research2249-782X0973-709X2023-10-011710010610.7860/JCDR/2023/60559.18511Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational StudyManju Bala0Susheela Taxak1Paras Bajaj2Monica Chhikara3Mangal Ahlawat4Ashwini Zokarkar5Associate Professor, Department of Anaesthesia and Critical Care, Pt. B D Sharma PGIMS, Rohtak, Haryana, India.Senior Professor, Department of Anaesthesia and Critical Care, Pt. B D Sharma PGIMS, Rohtak, Haryana, India.Senior Resident, Department of Critical Care, Paras Hospital, Gurgaon, Haryana, India.Associate Professor, Department of Anaesthesia and Critical Care, Pt. B D Sharma PGIMS, Rohtak, Haryana, India.Associate Professor, Department of Anaesthesia and Critical Care, Pt. B D Sharma PGIMS, Rohtak, Haryana, India.Senior Resident, Department of Anaesthesia, Safdargunj Hospital, Delhi, India.Introduction: Total Knee Arthroplasty (TKA) is a routinely used procedure for the management of knee osteoarthritis. Various haemodynamic changes can occur during TKA, especially during cementing and tourniquet deflation, which can have a significant impact on the patient’s clinical condition. This study emphasises the importance of close haemodynamic monitoring for the timely detection of potential complications during this procedure. Aim: To evaluate the haemodynamic changes occurring during spinal anaesthesia, bone cementation, and tourniquet deflation using Transthoracic Echocardiography (TTE) along with routine non invasive haemodynamic monitors in patients undergoing TKA. Materials and Methods: The present study was a prospective, observational single-arm study conducted at a tertiary care centre from February 2019 to March 202.Thirty patients of either sex, belonging to American Society of Anaesthesiologists physical status I (aged between 40-70 years) and scheduled for TKA under regional anaesthesia, were enrolled in the study. Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), SpO2 levels, respiratory rate, and End-Tidal CO2 (EtCO2 ) were recorded at various time intervals, including baseline value, after spinal anaesthesia, before cement implantation, after cement implantation, before tourniquet deflation, after tourniquet deflation, and at the end of the surgery. Blood gas analysis and TTE were recorded preoperatively, five minutes after cementation, and five minutes after tourniquet deflation. Data were collected and analysed using Student’s t-test for continuous variables and Chi-square test or Fisher’s exact test for nominal categorical variables. Statistical analysis was performed using the SPSS statistical package (version SPSS 17.0). Results: The mean age, weight, and height of the patients were 54.46±6.78 years, 66.43±5.31 kg, and 152.5±7.71 cm, respectively. The mean HR increased from 82.27±6.11 beats/ minute to 101.43±5.23 and 104.33+4.70 beats/minute after three and six minutes of cementation (p-value=0.001). The mean SBP increased from 121.67 mmHg to 144.13 mmHg and 138.87 mmHg after three and six minutes of cementation (p-value=0.001). The preoperative mean pH was 7.44, which decreased to 7.39 at five minutes after cement implantation and 7.38 after five minutes of tourniquet deflation (p-value=0.001). The preoperative mean PaCO2 value was 44.83 mmHg, which increased to 62.30 mmHg after five minutes of cement implantation and 55.17 mmHg after five minutes of tourniquet deflation (p-value<0.05). Conclusion: There was a significant increase in HR, blood pressure, and PaCO2 , as well as a decrease in pH after bone cement implantation. However, TTE performed at various time points did not suggest any significant changes during TKA. Hence, this study demonstrates that routine haemodynamic monitoring is sufficient, and no additional monitoring like ECHO is required in ASA 1 patients undergoing TKA.https://jcdr.net/articles/PDF/18511/60559_CE[Ra1]_F(KR)_QC(SHK_IS)_PF1(AG_OM)_PFA(AG_KM)_PN(KM).pdfarthroplastyechocardiographyend tidal co2tourniquet deflation |
| spellingShingle | Manju Bala Susheela Taxak Paras Bajaj Monica Chhikara Mangal Ahlawat Ashwini Zokarkar Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study Journal of Clinical and Diagnostic Research arthroplasty echocardiography end tidal co2 tourniquet deflation |
| title | Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study |
| title_full | Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study |
| title_fullStr | Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study |
| title_full_unstemmed | Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study |
| title_short | Evaluation of Haemodynamic Changes in Patients undergoing Total Knee Arthroplasty under Regional Anaesthesia: A Prospective Observational Study |
| title_sort | evaluation of haemodynamic changes in patients undergoing total knee arthroplasty under regional anaesthesia a prospective observational study |
| topic | arthroplasty echocardiography end tidal co2 tourniquet deflation |
| url | https://jcdr.net/articles/PDF/18511/60559_CE[Ra1]_F(KR)_QC(SHK_IS)_PF1(AG_OM)_PFA(AG_KM)_PN(KM).pdf |
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