Orthopedic surgery

Orthopaedic procedures are often performed on elderly patients.

The effects of anaesthesia can have a profound effect on blood pressure and cardiac output.

Observing why the blood pressure has changed with anaesthesia can lead to better decisions with fluids and drugs.

 

“LiDCOrapid may be used in fluid therapy for aged patients undergoing total hip replacement.”
Han et al. 2016

Orthopaedic procedures are often performed on elderly patients.

The effects of anaesthesia can have a profound effect on blood pressure and cardiac output.

Observing why the blood pressure has changed with anaesthesia can lead to better decisions with fluids and drugs.

Prevention of hypotension and a reduction in cardiac output could prevent post-operative complications in patients with low physiological reserve.

Monitoring the BIS to maintain optimal anaesthesia can reduce the risk of haemodynamic deterioration caused by excessive venodilation.

Commence monitoring pre-induction to determine baseline blood pressure and cardiac output.

The non-invasive CNAP can be used where arterial lines are not used.

Either passive leg raise or stroke volume/pulse pressure variation should be used to see if the patient is fluid responsive or not.

A fluid challenge guided by the response in the stroke volume should be used when fluids are given to prevent overfilling the patient.

If the patient is unresponsive to fluids with a low blood pressure then the appropriate drug can be used.

Use the BOS module to measure the effects of anaesthesia and titrate appropriately.

Application of LiDCO-Rapid in peri-operative fluid therapy for aged patients total hip replacement

Application of LiDCO-Rapid in peri-operative fluid therapy for aged patients total hip replacement

Patient Population
Total hip replacement.

LiDCO Monitor
LiDCOrapid fluid optimisation.

Trial Design
Randomised LiDCOrapid fluid optimisation vs conventional fluid management.

Outcome Impact
Lactate levels were significantly lower than seen in the conventionally managed subjects vasopressor requirements and complications were also significantly lower in the LiDCOrapid fluid optimized group.

OBJECTIVE
To explore a good strategy for fluid therapy, we observed the effect of application of LiDCOrapid on peri-operative hypotension and complications in aged patients undergoing total hip replacement, performed under combined spinal-epidural anesthesia (CSEA).

METHODS
Forty patients were randomly divided into normal fluid therapy group (group N) and LiDCOrapid guiding fluid therapy group (group L). For group N, anytime mean arterial pressure (MAP) was less than 65 mmHg, a rapid intravenous infusion of 150 ml hydroxyethyl starch solution (HES,130/0.4, 6%) was given. For group L, whenever stroke volume variation (SVV) was more than 10%, HES (130/0.4,6%) was also given to patients until SVV returned to normal limits. After administration of HES, MAP still less than 65 mmHg called for 25-50 μg of phenylephrine to be given to maintain normal MAP in both groups. Heart rate (HR), MAP and lactate level of arterial blood (LAC) was compared between the two groups as prior to anesthesia (T0); instantly (T1), 15 min (T2), 30 min (T3), 60 min (T4), 90 min (T5) after spinal anesthesia; and at the end of surgery (T6).

RESULTS
MAP and HR were significantly higher in group L than in group N at T4 to T6 (all P<0.05). LAC was significantly lower in group L than in group N at T5 and T6 (all P<0.05). Phenylephrine requirements and incidences of peri-operative complications were also significantly lower in group L than in group N (all P<0.05).

CONCLUSION
LiDCOrapid may be used in fluid therapy for aged patients undergoing total hip replacement.

Han G, Liu K, Xue H, Zhao P. Application of LiDCO-Rapid in peri-operative fluid therapy for aged patients undergoing total hip replacement. Int J Clin Exp Med 2016;9(2):4473-4478, www.ijcem.com /ISSN:1940-5901/IJCEM0010819

Lactate levels were significantly lower than seen in the conventionally managed subjects vasopressor requirements and complications were also significantly lower in the LiDCOrapid fluid optimized group.

LiDCOrapid – Hemodynamic Monitoring in Action

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“LiDCOrapid may be used in fluid therapy for aged patients undergoing total hip replacement.”
Han et al. 2016

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