Observation the change of ScvO2 after tourniquet release in simultaneous bilateral total knee replacement patients
Date Issued
2007
Date
2007
Author(s)
Jeng, Chuen-Shin
DOI
zh-TW
Abstract
Tourniquet use is indicated in total knee arthroplasty(TKA), but it has multiple complications such as hypotension, myocardial infraction (MI), pulmonary embolism and reperfusion injury caused by release of free radials, chemokines, cytokines. Although patients undergoing bilateral TKA (BTKR) procedure were criticized to have more perioperative risks of MI，cardiovascular accidents and need more blood transfusion，oxygen supply and post-operative intensive care，many orthopedics surgeons claimed that patients had more satisfaction，rehabilitation，and less cost. Since increased perioperative risks happen，more hemodynamic monitors are needed during and post operative periods. Oxygen satuarion of central vena cava(ScvO2) is commonly used in emergency department and intensive care unit for detection of sufficient oxygen supply. Although it can't really mimic the true level of venous oxygen saturation， the lower ScvO2 (<70%) is thought to be hypoperfusion in early-goal directed therapy trial. Thus we want to use this more convenient and less complications tool to monitor BTKA patients to see if there were any hypoperfusion change during and postoperative periods and the correlation of other hemodynamic parameters.
After IRB approved，we collected eighteen patients who received simultaneous BTKR in the operation. Exclusion criteria were severe heart，lung，or liver disease，CVA history，and severe coagulopathy. Patients received combined spinal/epidural anesthesia with arterial catheter and central venous catheter implantation for monitoring vital signs and ScvO2 during the operation. Crystalloid solution was used to supply volume defect if hemoglobin of the patient was above 10 g/dl. Blood pressure, heart rate, SpO2, and ScvO2 were recorded by computer every minute from the start of the operation till 3hours later post second tourniquet release. Blood samples for arterial blood gas analysis and cytokines were drawn at beginning of the operation, five minutes before and fifteen minutes after the tourniquet release, and 90 and 180 minutes after the second tourniquet release. The data was analyzed by using one-way analysis of variance (ANOVA), and repeated measures analysis to analyze blood samples data and to compare the hemodynamic response and ScvO2 changes. We found that the values of pH, pCO2, base excess, HCO3-, Hct and Hb had significant difference during the operation. Interleukin1-β was elevated significantly after second tourniquet was released，and it meant that inflammatory process was increased in BTKR patients. In eleven patients, ScvO2 had dropped below 65% after the tourniquet was released, which meant there had oxygen supply deficit or oxygen consumption increased. Besides, ScvO2 was affected by multiple factors, such as BMI, INR level, pre-operative heart rate and blood pressure. Arrhythmia, LVH, and hemoglobin level affected ScvO2 level post-operatively. All data and previous studies showed that we actually need ScvO2 for monitoring BTKR surgery because standard monitors now we use intraoperatively can not mimic or predict the level of ScvO2 or the balance of oxygen supply and demand.
Subjects
雙側膝關節置換
術中監測
半身麻醉
細胞激素
中央靜脈血氧飽和度
total knee replacement, bilateral
Saturation of central venous oxygen, ScvO2
monitor, intraoperative
anesthesia, spinal
cytokines
Type
text
File(s)![Thumbnail Image]()
Loading...
Name
ntu-96-P93421007-1.pdf
Size
23.31 KB
Format
Adobe PDF
Checksum
(MD5):416e5dfaeffa483c1ab8aa802fc66573