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Related Experiment Videos

Postoperative hemodynamic instability after simultaneous bilateral total knee arthroplasty.

Christopher M Reidy1, Michael L Beach, John D Gallagher

  • 1Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA. reidy.christopher@gmail.com

Journal of Patient Safety
|April 20, 2011
PubMed
Summary

Bilateral total knee replacement commonly causes hypotension. Spinal anesthesia is a significant risk factor for this complication compared to general anesthesia, suggesting general anesthesia may be safer.

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Area of Science:

  • Anesthesiology
  • Orthopedic Surgery
  • Cardiovascular Physiology

Background:

  • Bilateral total knee arthroplasty (TKA) can be associated with significant hemodynamic changes.
  • Clinical observations suggested a high incidence of severe postoperative hypotension and bradycardia following simultaneous bilateral TKA.

Purpose of the Study:

  • To determine the incidence of postoperative hemodynamic instability after bilateral TKA.
  • To identify risk factors associated with postoperative hypotension and bradycardia.

Main Methods:

  • Retrospective review of 312 patients undergoing bilateral TKA.
  • Defined hypotensive events as systolic blood pressure < 85 mm Hg or need for emergency medical management.
  • Used logistic regression to identify risk factors.

Main Results:

  • The incidence of hypotensive events was 17%; simultaneous hypotension and bradycardia occurred in 7%.
  • 10% of patients required emergent vasopressor or vagolytic treatment.
  • Spinal anesthesia was an independent risk factor for hypotension (21%) compared to general anesthesia (5.7%).

Conclusions:

  • Hypotension is a common complication after bilateral TKA.
  • Spinal anesthesia is a significant risk factor for postoperative hypotension compared to general anesthesia.
  • General anesthesia may provide better hemodynamic stability and safety for this procedure.