الفهرس 
TOTAL KNEE REPLACEMENT UNDER SPINAL ANAESTHESIAOnly 14 pages are availabe for public view
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Abstract
This was a Prospective, observational study conducted on 60 patients with
Total Knee Replacement (TKR); to characterize the collapsibility index of the IVC
as a potential screening tool to identify patients who are candidate for
hypotensive events after tourniquet release in TKR in an otherwise
hemodynamically stable population.
We found that; the mean age of all patients was (57 ± 5.6) years. Regarding
gender of the patients, (58.3%) of patients were females; while (41.7%) were
males.
Regarding basic clinical data; the mean BMI of all patients was (25.7 ± 2.5);
with (60%) of patients had DM, and (56.7%) had HTN.
Regarding ASA class, (3.3%) had class I, (73.3%) had class II, and (23.3%) had
class III.
Regarding Baseline hemodynamic data; the average MAP was (104.6 ± 6)
mmHg, the average RR was (10.5 ± 1.3) breath/min, and the average HR was
(74.75 ± 7) beat/min.
Regarding Data before tourniquet release; the average MAP was (102.3 ±
7.5) mmHg, the average RR was (10.7 ± 1.2) breath/min, and the average HR was
(75.3 ± 6.5) beat/min, with average IVC-CI of (48.4 ± 7.7).
Regarding Data 15-m after tourniquet release; the average MAP was (93.1 ±
9.3) mmHg, the average RR was (10.7 ± 1.4) breath/min, and the average HR was
(76.45 ± 6.6) beat/min, with average IVC-CI of (51 ± 8.4).
Regarding final outcome, (11.7%) of patients suffered Hypotension (PTRH).
The 60 TKR patients were classified according to outcomes into 2
independent groups: group A IVCCI >55,5% (12 patients) and group B IVCCI
<55,5% (48 patients).
Regarding comparative study between the 2 groups as regards
demographic data; no statistically significant differences were found except for
ASA physical status of patients where group A had patients in ASA I class and most
of its patients are ASA II while group B had no patients in ASA I class and a quarter
of its patients were ASA III.
Regarding comparative study between the 2 groups as regards
hemodynamic and ultrasonographic data; no statistically different results were
noted between groups in baseline readings. Results recorded before tourniquet
release showed that IVC during inspiration reading was statistically lower while
IVC collapsibility index was statistically higher in group A when compared with
group B . Results recorded 15 min after tourniquet release showed that IVC during
inspiration reading was statistically lower while IVC collapsibility index was
statistically higher in group A when compared with group B, the IVC-CI before
tourniquet release was not correlated with percent reduction in systolic blood
pressure after tourniquet release in both groups with high (group A) or low IVC-CI
(group B).
Comparing patients who developed hypotension versus patients who did
not , the 60 TKR patients were classified into hypotensive (7 patients) and
normotensive (53 patients) groups.
No statistically significant differences were found between hypotensive
versus normotensive patients concerning demographic data and data recorded
before tourniquet release. Baseline data showed significantly higher respiratory
rate in hypotensive patients. Data recorded 15 min after tourniquet release
showed statistically lower SBP, DBP and MAP, significantly higher HR and
significantly lower IVC during inspiration and expiration in patients who
developed hypotension.
We studied different factors that may be included before tourniquet
release that may predict the degree of PTRH by using ROC-curve analysis. IVC-CI
before tourniquet release and BMI failed to be predictive factors for the
occurrence of PTRH, while respiratory and heart rates before tourniquet release
significantly predict the occurrence of PTRH.
Performing multiple regression analysis using forward method showed that
the increase in RR had an independent effect on increasing the probability of
PTRH occurrence; with significant statistical difference (p < 0.039).
Conclusion : IVC-CI before tourniquet release is not a predictor for PTRH in
patients undergoing TKR under spinal anesthesia