title: Pulmonary circulatory changes after bilateral total knee arthroplasty during regional anesthesia.
abstract: OBJECTIVE
  To monitor the pulmonary hemodynamics of patients undergoing bilateral total knee arthroplasty (BTKA) intraoperatively and up to 24 hours following surgery.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University-affiliated teaching hospital.
  
  
  METHODS
  30 ASA physical status 2 and 3 patients scheduled for single-stage, cemented BTKA during epidural anesthesia.
  
  
  METHODS
  Pulmonary artery catheters were in all patients.
  
  
  METHODS
  Systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), the ratio of PVR to SVR at baseline, at the beginning of surgery, and after each knee implantation were recorded and compared with measurements taken one day postoperatively (POD 1).
  
  
  RESULTS
  On POD 1, PVR/SVR was increased by 30% compared with baseline (P < 0.0001) and by 20% versus the end of surgery (P < 0.0001). Systemic vascular resistance decreased during surgery and was significantly lower than baseline at 24 hours after surgery (P < 0.0001). No significant change in PVR was noted during surgery.
  
  
  CONCLUSIONS
  The PVR/SVR ratio on the day following BTKA was increased. This change may represent the different effects of inflammatory perioperative stresses on the pulmonary and systemic vasculature.
authors: Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA. bombardieri.am@gmail.com
authors: Anna Maria
authors: AM
authors: Bombardieri
authors: Stavros G
authors: SG
authors: Memtsoudis
authors: George
authors: G
authors: Go
authors: Yan
authors: Y
authors: Ma
authors: Thomas
authors: T
authors: Sculco
authors: Nigel
authors: N
authors: Sharrock
mesh_terms: D000368:Aged; D000767:Anesthesia, Epidural; D019645:Arthroplasty, Replacement, Knee; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000502:physiology; D011652:Pulmonary Circulation / Q000502:physiology*; D014655:Vascular Resistance / Q000502:physiology
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