Comparison of haemodynamic parameters in two different geriatric age groups undergoing cemented bipolar hemiarthroplasty

Authors

  • Shruti Shrikant Patil Department of Anaesthesiology, LTMMC & LTMG Hospital, Sion, Mumbai, Maharashtra, India
  • Manish Kotwani Department of Anaesthesiology, LTMMC & LTMG Hospital, Sion, Mumbai, Maharashtra, India
  • Smita S. Lele Department of Anaesthesiology, LTMMC & LTMG Hospital, Sion, Mumbai, Maharashtra, India
  • Anoop C. Dhamangaonkar Department of Orthopaedics, LTMMC & LTMG Hospital, Sion, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20195534

Keywords:

Bone cement, Geriatric, Haemodynamic, Hemiarthroplasty

Abstract

Background: To conduct a prospective observational study to compare the haemodynamic changes in two age groups, group A: 60-75yrs and group B: >75yrs during cemented bipolar hemiarthroplasty for hip fractures under spinal anaesthesia.

Methods: Patients of either sex belonging to above two groups, with no contra-indications for central neuraxial block received spinal anesthesia at lumbar level. Heart Rate (HR), Systolic Blood Pressure(SBP), Diastolic Blood Pressure(DBP) and Mean Arterial Pressure(MAP), pulse pressure variability(PPV), arterial oxygen saturation (SpO2), Electrocardiogram for any changes and nasal  end tidal CO2 (EtCO2) were recorded at the following time points:  baseline(on table), after giving spinal, after giving surgical position, at the start of surgery, at femoral canal reaming, immediately after cement insertion, every 2 minutes after cement insertion, femoral joint reduction and the end of the surgery. Hypotension, bradycardia, arrythmias, desaturation or unexpected loss of consciousness occurring in peri-cementation period suggestive of ‘Bone cement implantation syndrome’(BCIS) or any other adverse event was recognized and treated.

Results: The SBP, HR, PPV, ETCO2, SPO2 and incidence of adverse events; were comparable in both the groups. The difference in the DBP and MAP was statistically significant.

Conclusions: The difference in the occurrence of haemodynamic alterations was more in the older age group. Continuous vigilant monitoring during bipolar hemiarthroplasty is required.

References

Age groupwise percentage of population (1971-2016). India: Datanet India, Inc.’s 2000. Available at: https://www.indiastat.com/demographics data/7/age-group-wise-population/330675/age-group-wise-percentage-of-population-1971-2016/12977/stats.aspx. Accessed on 5th January 2019.

Park HJ, Kang H, Lee JW, Baek SM, Seo JS. Comparison of hemodynamic changes between old and very old patients undergoing cemented bipolar hemiarthroplasty under spinal anesthesia. Korean J anesthesiol. 2015;68(1):37.

Mariano ER. Anesthesia for Orthopedic Surgery.In: Butterworth J.F, Mackey D.C,WasnickJ.D, editors. Morgan and Mikhails Clinical Anesthesiology. 5th ed. New York: McGraw Hill Lange; 2013;789-804.

Donaldson AJ, Thomson HE, Harper NJ, Kenny NW. Bone cement implantation syndrome. British J anaesth. 2009;102(1):12-22.

Heisel C, Clarius M, Schneider U, Breusch SJ. Thromboembolic complications related to the use of bone cement in hip arthroplasty-pathogenesis and prophylaxis. Zeitschrift fur Orthopadie und ihre Grenzgebiete. 2001;139(3):221-8.

Byrick RJ, Bell RS, Kay JC, Waddell JP, Mullen JB. High-volume, high-pressure pulsatile lavage during cemented arthroplasty. The Journal of bone and joint surgery. American volume. 1989;71(9):1331-6.

Pietak S, Holmes J, Matthews R, Petrasek A, Porter B. Cardiovascular collapse after femoral prosthesis surgery for acute hip fracture. Canad J anaesth. 1997;44(2):198-201.

Byrick RJ. Cement implantation syndrome: a time limited embolic phenomenon. Can J Anaesth1997;44: 107-11.

Yurdakul E, Karaaslan F, Korkmaz M, Duygulu F, Baktır A. Is cemented bipolar hemiarthroplasty a safe treatment for femoral neck fracture in elderly patients?. Clinical interventions in aging. 2015;10:1063.

Mudgalkar N, Ramesh KV. Bone cement implantation syndrome: A rare catastrophe. Anesthesia, essays and researches. 2011;5(2):240.

Modig J, Busch C, Olerud S, Saldeen T, Waernbaum G. Arterial hypotension and hypoxaemia during total hip replacement: the importance of thromboplastic products, fat embolism and acrylic monomers. Acta Anaesthesiol Scand.1975;19:28-43.

Parvizi J, Holiday AD, Ereth MH, Lewallen DG. Sudden death during primary hip arthroplasty.Clin Orthop Relat Res. 1999;369:39-48.

Urban MK, Sheppard R, Gordon MA, Urquhart BL. Right ventricular function during revision total hip arthroplasty. Anesth Analg. 1996;82(6):1225-9.

Kotyra M, Houltz E, Ricksten SE. Pulmonary haemodynamics and right ventricular function during cemented hemiarthroplasty for femoral neck fracture. Acta Anaesthesiol Scand. 2010;54(10):1210-6.

Bengtson AN, Larsson M, Gammer W, Heideman M. Anaphylatoxin release in association with methylmethacrylate fixation of hip prostheses. J Bone Joint Surg.1987;69(1):46-9.

Soleimanha M, Sedighinejad A, Haghighi M, Nabi BN, Mirbolook AR, Mardani-Kivi M. Hemodynamic and arterial blood gas parameters during cemented hip hemiarthroplasty in elderly patients. Archiv Bone Joint Surg. 2014;2(3):163.

Issack PS, Lauerman MH, Helfet DL, Sculco TP, Lane JM. Fat embolism and respiratory distress associated with cemented femoral arthroplasty. Am J Orthoped (Belle Mead, NJ). 2009;38(2):72-6.

Kanonidou Z, Karystianou G. Anesthesia for the elderly. Hippokratia. 2007;11:175-7.

Sieber F, Pauldine R. Geriatric Anesthesia. In: Ronald D. Miller, Neal H. Cohen, editors. Millers Anaesthesia. 8thed. Philadelphia: Elsevier Saunders; 2015;2798-818.

Lafont ND, Kalonji MK, Barre J, Guillaume C, Boogaerts JG. Clinical features and echocardiography of embolism during cemented hip arthroplasty. Can J Anaesth.1997;44:112-7.

Qi X, Zhang Y, Pan J, Ma L, Wang L, Wang J. Effect of bone cement implantation on haemodynamics in elderly patients and preventive measure in cemented hemiarthroplasty. BioMed res intern. 2015;2015.

Ereth MH, Weber JG, Abel MD, Lennon RL, Lewallen DG, Ilstrup DM, et al. Cemented versus noncemented total hip arthroplasty-embolism, hemodynamics, and intrapulmonary shunting. In Mayo Clinic Proceedings 1992;67:1066-74.

Olsen F, Kotyra M, Houltz E, Ricksten SE. Bone cement implantation syndrome in cemented hemiarthroplasty for femoral neck fracture: incidence, risk factors, and effect on outcome. British J Anaesth. 2014;113(5):800-6.

Oliveira-Costa CD, Friedman G, Vieira SR, Fialkow L. Pulse pressure variation and prediction of fluid responsiveness in patients ventilated with low tidal volumes. Clin. 2012;67(7):773-8.

Grassi P, Nigro LL, Battaglia K, Barone M, Testa F, Berlot G. Pulse pressure variation as a predictor of fluid responsiveness in mechanically ventilated patients with spontaneous breathing activity: a pragmatic observational study. HSR proceedings in intensive care cardiovas anesthes. 2013;5(2):98.

Lopes MR, Oliveira MA, Pereira VO, Lemos IP, Auler JO, Michard F. Goal-directed fluid management based on pulse pressure variation monitoring during high-risk surgery: a pilot randomized controlled trial. Critical Care. 2007 Oct;11(5):R100.

Hong DM, Lee JM, Seo JH, Min JJ, Jeon Y, Bahk JH. Pulse pressure variation to predict fluid responsiveness in spontaneously breathing patients: tidal vs forced inspiratory breathing. Anaesthesia. 2014;69(7):717-22.

Koessler MJ, Fabiani R, Hamer H, Pitto RP. The clinical relevance of embolic events detected by transesophageal echocardiography during cemented total hip arthroplasty: a randomized clinical trial. Anesth Analg. 2001;92(1):49-55.

Covert CR, Fox GS. Fox. Anaesthesia for hip surgery in the elderly. Can J Anaesth. 1989;36:311-9.

Downloads

Published

2019-11-27

How to Cite

Patil, S. S., Kotwani, M., Lele, S. S., & Dhamangaonkar, A. C. (2019). Comparison of haemodynamic parameters in two different geriatric age groups undergoing cemented bipolar hemiarthroplasty. International Journal of Research in Medical Sciences, 7(12), 4656–4662. https://doi.org/10.18203/2320-6012.ijrms20195534

Issue

Section

Original Research Articles