Skip Navigation



BJA Advance Access published online on April 27, 2009
British Journal of Anaesthesia, doi:10.1093/bja/aep083
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
102/6/756    most recent
aep083v1
Right arrow E-Letters: Submit a response to the article
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Bundgaard-Nielsen, M.
Right arrow Articles by Kehlet, H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bundgaard-Nielsen, M.
Right arrow Articles by Kehlet, H.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Orthostatic intolerance and the cardiovascular response to early postoperative mobilization

M. Bundgaard-Nielsen1,2,*, C. C. Jørgensen1,2, T. B. Jørgensen2, B. Ruhnau2, N. H. Secher2 and H. Kehlet1

1 Section of Surgical Pathophysiology
2 Department of Anaesthesia, Rigshospitalet, University of Copenhagen, DK-2100 Copenhagen, Denmark

* Corresponding author. E-mail: morten.bundgaard-nielsen{at}rh.regionh.dk

Background: A key element in enhanced postoperative recovery is early mobilization which, however, may be hindered by orthostatic intolerance, that is, an inability to sit or stand because of symptoms of cerebral hypoperfusion as intolerable dizziness, nausea and vomiting, feeling of heat, or blurred vision. We assessed orthostatic tolerance in relation to the postural cardiovascular responses before and shortly after open radical prostatectomy.

Methods: Orthostatic tolerance and the cardiovascular response to sitting and standing were evaluated on the day before surgery and 6 and 22 h after operation in 16 patients. Non-invasive systolic (SAP) and diastolic arterial pressure (DAP) (Finometer®), heart rate, cardiac output (CO, Modelflow®), total peripheral resistance (TPR), and central venous oxygen saturation (ScvO2) were monitored.

Results: Before surgery, no patients had symptoms of orthostatic intolerance. In contrast, 8 (50%) and 2 (12%) patients were orthostatic intolerant at 6 and ~22 h after surgery, respectively. Before surgery, SAP, DAP, and TPR increased (P<0.05), whereas CO did not change (P>0.05) and ScvO2 decreased (P<0.05) upon mobilization. At 6 h after operation, SAP and DAP declined with mobilization (P<0.05) and the arterial pressure response differed from the preoperative response both upon sitting (P<0.05) and standing (P<0.05) due to both impaired TPR and CO. At ~22 h, the SAP and DAP responses to mobilization did not differ from the preoperative evaluation (P>0.05).

Conclusions: The early postoperative postural cardiovascular response is impaired after radical prostatectomy with a risk of orthostatic intolerance, limiting early postoperative mobilization. The pathogenic mechanisms include both impaired TPR and CO responses.

Keywords: anaesthesia, general; recovery, postoperative; surgery, postoperative period


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?




Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.