Predictive Factors for Hypotensive Bradycardic Events During Arthroscopic Shoulder Surgery
Study Details
Study Description
Brief Summary
Patients's demographics and perioperative factors affect the occurrence of hypotensive bradycardic events in the patients undergoing arthroscopic shoulder surgery in the sitting position under interscalene block.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Patients' age, Side of the block,Horner's syndrome, the degree of blockade, preoperative fasting time and fluid administration volume, waiting time for sitting position after the block, intraoperative use of opioids and antihypertensives, and change of heart rate variability before the block and after sitting position affect the occurrence of hypotensive bradycardic events in the patients undergoing arthroscopic shoulder surgery in the sitting position under interscalene block.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Hypotensive bradycardic event The participants are assigned to hypotensive bradycardic event (HBE) group when they experience signs or symptoms associated with syncope, hypotension, or bradycardia, which are treated with vasopressors or inotropics following sitting position after interscalene brachial plexus block is done. Otherwise, they are assigned to non-HBE group. |
Other: Interscalene brachial plexus block
After sterile draping around interscalene groove with povidone, a nerve stimulating needle connected to a nerve stimulator is inserted through the interscalene groove. Following involuntary contraction of shoulder, arm, forearm, or hand muscles with 0.5 milliamperes at 1 Hz using the nerve stimulator, 30 to 40 ml of mixture of 1% mepivacaine 20 ml and 0.75% ropivacaine 20 ml are injected.
|
Outcome Measures
Primary Outcome Measures
- Patient's age and gender, fasting time, administered volume, blood pressure, and heart rate variability [Prior to ISBPB]
Patients'age and gender, preoperative fasting time and volume of fluid administered, pre-block mean arterial pressure and heart rate, logarithmically transformed low frequency, high frequency, and total power of heart rate variability
Secondary Outcome Measures
- Side of the block, volume of local anesthetics used, number of patients having Horner's syndrome, hoarseness, and subjective dyspnea, degree of dermatomal and motor blockade [20 minutes after the end of local anethetics injection]
Side of the block, volume of local anesthetics used, number of patients having Horner's syndrome (ptosis, miosis, and anhidrosis), hoarseness, and subjective dyspnea, degree of dermatomal blockade (C5, C6, C7, C8, and T1), and degree of motor blockade (median, ulnar, radial, and musculocutaneous nerve)
- Waiting time for sitting position, heart rate variability, mean arterial pressure, heart rate, frequency of antihypertensives and opioids use, and onset of hypotensive bradycardic events [after the sitting position (expected average of 2 hours including surgery readiness time and duration of surgery)]
Waiting time for sitting position (time from the end of interscalene brachial plexus block to the sitting position), logarithmically transformed high frequency, low frequency, and total power of heart rate variability, mean arterial pressure, heart rate, frequency of intraoperative use of antihypertensives and opioids, and onset of hypotensive bradycardic events
Eligibility Criteria
Criteria
Inclusion Criteria:
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Age between 15 and 80 years
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American Society of Anesthesiologists physical status I-II
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Body mass index < 35 kg/m2
Exclusion Criteria:
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Coagulation deficiencies
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Known allergies to local anesthetics
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Neurologic deficit on the side to be operated
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Inflammation at the puncture site for interscalene brachial plexus block
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Coronary artery disease
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Cardiac conduction disorders and arrhythmias
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Congestive heart disease
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Diabetes mellitus
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Serum electrolyte abnormalities
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Autonomic dysfunction
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Psychiatric disorders
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Patients refusal
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Communications difficulties
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Failure of interscalene brachial plexus block
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Daegu Catholic University Medical Center | Daegu | Korea, Republic of | 705-718 |
Sponsors and Collaborators
- Daegu Catholic University Medical Center
Investigators
- Study Chair: WoonSeok Roh, Doctor, Daegu Catholic University Medical Center
Study Documents (Full-Text)
None provided.More Information
Publications
- Liguori GA, Kahn RL, Gordon J, Gordon MA, Urban MK. The use of metoprolol and glycopyrrolate to prevent hypotensive/bradycardic events during shoulder arthroscopy in the sitting position under interscalene block. Anesth Analg. 1998 Dec;87(6):1320-5.
- Sia S, Sarro F, Lepri A, Bartoli M. The effect of exogenous epinephrine on the incidence of hypotensive/bradycardic events during shoulder surgery in the sitting position during interscalene block. Anesth Analg. 2003 Aug;97(2):583-588. doi: 10.1213/01.ANE.0000070232.06352.48.
- Simeoforidou M, Vretzakis G, Chantzi E, Bareka M, Tsiaka K, Iatrou C, Karachalios T. Effect of interscalene brachial plexus block on heart rate variability. Korean J Anesthesiol. 2013 May;64(5):432-8. doi: 10.4097/kjae.2013.64.5.432. Epub 2013 May 24.
- Song SY, Roh WS. Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks. Korean J Anesthesiol. 2012 Mar;62(3):209-19. doi: 10.4097/kjae.2012.62.3.209. Epub 2012 Mar 21.
- CR-11-072