The Impact of Hypotensive Epidural Anesthesia on Distal and Proximal Tissue Perfusion in Patients Undergoing Total Hip Arthroplasty
- *Corresponding Author:
- Stavros G Memtsoudis, MD, PhD, FCCP
Department of Anesthesiology
Hospital for Special Surgery, Weill Cornell Medical College
535 East 70th Street, New York, NY 10021, USA
E-mail: [email protected]
Received date: September 27, 2013; Accepted date: November 27, 2013; Published date: November 29, 2013
Citation: Danninger T, Stundner O, Ma Y, Bae JJ, Memtsoudis SG (2013) The Impact of Hypotensive Epidural Anesthesia on Distal and Proximal Tissue Perfusion in Patients Undergoing Total Hip Arthroplasty. J Anesth Clin Res 4:366. doi: 10.4172/2155-6148.1000366
Copyright: © 2013 Danninger T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Little data exists to detail the effect of hypotensive epidural anesthesia on differential tissue oxygenation changes above and below the level of neuraxial blockade. This study was designed to study tissue oxygenation in a clinical setting, using non-invasive near-infrared spectroscopy.
Methods: Patients aged 18 to 85 scheduled to undergo primary total hip arthroplasty were enrolled. Muscle oxygenation saturation was measured above and below the level of neuraxial blockade (deltoid and vastus lateralis muscles). Other continuously recorded parameters included cardiac output, stroke volume, heart rate, invasive mean arterial blood pressure and arterial oxygen saturation. Recordings of muscle oxygenation were compared over time separately for upper and lower extremity.
Results: 10 patients were enrolled. We found an intermittent and significant unadjusted decline of mean muscle oxygenation saturation in the vastus lateralis muscle during first part of the surgery (nadir 2nd quintile: 71.0% vs. 63.3%, p<0.0001). This decline was followed by a return to baseline towards the end of the surgery (71.0% vs. 69.1%, p=0.3429). Mean muscle oxygenation saturation did not change for the same period of time in the deltoid muscle. When adjusting for covariates, the changes in muscle tissue oxygenation remained significant.
Conclusion: These results indicate that muscle oxygenation saturation, a surrogate parameter for tissue perfusion, is decreased by hypotensive epidural anesthesia, but only within the functional limits of the neuraxial blockade. The etiology of these findings remains to be elucidated.