Wardle Mikaela, Nair Amanda, Saunders Sarah, Armstrong Iain, Charalampopoulos Athanasios, Elliot Charlie, Hameed Abdul, Hamilton Neil, Harrington John, Keen Carol, Lewis Robert, Sabroe Ian, Thompson A A Roger, Kerry Robert M, Condliffe Robin, Kiely David G
Sheffield Pulmonary Vascular Disease Unit Sheffield Teaching Hospitals NHS Trust Sheffield UK.
Department of Anaesthetics Sheffield Teaching Hospitals NHS Trust Sheffield UK.
Pulm Circ. 2022 Mar 25;12(1):e12019. doi: 10.1002/pul2.12019. eCollection 2022 Jan.
Patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH) are at increased risk when undergoing anesthesia and major surgery. Data on outcomes for elective orthopedic surgery in patients with PH are limited. A patient pathway was established to provide access to elective lower limb arthroplasty. This included assessment of orthopedic needs, fitness for anesthesia, preoperative optimization, and intra- and postoperative management. Patient data were retrospectively retrieved using patient's hospital records. Between 2012 and 2020, 29 operations (21 total hip replacements [THRs], 7 total knee replacements [TKRs], 1 total hip revision) were performed in 25 patients (mean age: 67 years). Perioperatively, 72% were treated with low-dose intravenous prostanoid. All had arterial lines, and central access and perioperative lithium dilution cardiac output monitoring was used in 86% of cases. Four patients underwent GA, 21 spinal anesthesia, and 4 CSE anesthesia. Supplemental nerve blocks were performed in all patients undergoing general, and 12 of 21 undergoing spinal anesthesia. All were managed in high dependency postoperatively. Hospital length of stay and complication rates were higher than reported in non-PH patients. Perioperative complications included hypotension requiring vasopressors ( = 10), blood transfusion ( = 7), nonorthopedic infection ( = 4), and decompensated right heart failure ( = 1). There was no associated mortality. All implants were functioning well at 6 weeks and subsequent follow-up. EmPHasis-10 quality of score decreased by 5.5 (±2.1) ( = 0.04). A dedicated multiprofessional pathway can be used to safely select and manage patients with PH through elective lower limb arthroplasty.
肺动脉高压和慢性血栓栓塞性肺动脉高压（PH）患者在接受麻醉和大手术时风险增加。关于PH患者择期骨科手术结局的数据有限。已建立了一条患者路径，以提供择期下肢关节置换术的机会。这包括评估骨科需求、麻醉适宜性、术前优化以及术中和术后管理。使用患者的医院记录回顾性检索患者数据。2012年至2020年期间，25例患者（平均年龄：67岁）进行了29例手术（21例全髋关节置换术[THR]，7例全膝关节置换术[TKR]，1例髋关节翻修术）。围手术期，72%的患者接受了低剂量静脉用前列环素治疗。所有患者均有动脉导管，86%的病例使用了中心静脉通路和围手术期锂稀释心输出量监测。4例患者接受全身麻醉（GA），21例接受脊髓麻醉，4例接受腰麻-硬膜外联合麻醉（CSE）。所有接受全身麻醉的患者以及21例接受脊髓麻醉患者中的12例均进行了补充神经阻滞。所有患者术后均在高依赖病房进行管理。住院时间和并发症发生率高于非PH患者的报道。围手术期并发症包括需要血管升压药的低血压（n = 10）、输血（n = 7）、非骨科感染（n = 4）和失代偿性右心衰竭（n = 1）。无相关死亡病例。所有植入物在6周及后续随访时功能良好。EmPHasis - 10质量评分下降了5.5（±2.1）（p = 0.04）。一条专门的多专业路径可用于通过择期下肢关节置换术安全地选择和管理PH患者。
