Cerebral Oxygenation in Total Hip Arthroplasty Patients (THANIRS)

Hospital for Special Surgery (HSS)

Status

Completed

Conditions

Post-operative Delirium

Cerebral Oxygen Desaturation

Treatments

Device: Cerebral Oximeter

Study type

Interventional

Funder types

Other

Identifiers

NCT02325154

2014-047

Details and patient eligibility

About

We plan to investigate the relationship between hypotensive epidural anesthesia for hip arthroplasty and cerebral oxygen saturation.

Full description

The relationship between cerebral oxygenation and blood pressure in patients undergoing hypotensive epidural anesthesia has not been completely elucidated. Previous publications have demonstrated a low incidence of post-op cognitive dysfunction in patients undergoing hypotensive epidural anesthesia for total hip replacement (1-3) and that cerebral blood flow velocity is preserved as measured by transcranial Doppler (4). An earlier investigation by Dr. Yadeau demonstrated infrequent cerebral oxygen desaturation in spontaneously breathing patients undergoing shoulder arthroscopy, even in the presence of hypotension (4), but did not investigate outcomes in the cognitive domain or have a control group of patients undergoing surgery with general anesthesia. There has only been one study looking at cerebral oxygenation and hip surgery, which was performed in elderly patients with fractures. It demonstrated that patients with low pre-op regional cerebral oxygen saturation (rSO2) had higher incidence of delirium (5) but many of those patients had surgery under general anesthesia. Given the costs associated with post-op delirium, cognitive dysfunction and stroke (6) and based on the fact that previous publications from this institution have demonstrated both a low incidence of cognitive dysfunction and preservation of cerebral blood flow velocity using this anesthetic technique, we hypothesized that cerebral oxygen desaturation will not occur in this population.

Enrollment

100 patients

Sex

All

Ages

18 to 80 years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

Patients 18-80 years old undergoing unilateral total hip arthroplasty
Hypotensive epidural anesthesia

Exclusion criteria

Contraindication to controlled hypotension and/or neuraxial anesthesia.
Severe pulmonary hypertension or pre-op systolic blood pressure reading >150 mm Hg
Moderate to severe valvular stenosis.
History of stroke, dementia, or post-op delirium
Prior OSA diagnosis
History of benzodiazepine use (regular use for longer than 3 months)
Chronic renal or hepatic disease (renal failure, history of liver failure, cirrhosis)
History of alcoholism or heavy alcohol intake (defined as averaging more than 3 drinks per night; recovery is OK)
Parkinson's disease
Severe chronic pulmonary disease
Total anterior hip approach being used
Hip resurfacing procedure
Non-English Speaking*
- Questionnaires being used to assess mental status are only validated in English.