title: Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.
abstract: Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results  Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P<0.001],platelets [(275.0±71.3)×10(9)/L vs. (237.7±68.0)×10(9)/L,P=0.048] and neutrophils [(4.7±1.7)×10(9)/L vs. (3.9±1.4)×10(9)/L,P=0.044] and higher incidence of pulmonary function abnormality (42.9% vs.16.7%,P=0.024).More AS patients were induced with scoline (14.3% vs.0,P=0.012). More AS patients underwent THA with Mallampati classification 3 (28.6% vs.7.1%,P=0.022),reduced neck extension(47.6% vs.2.4%,P<0.001),Cormack-Lehane classification2(56.3% vs.15.4%,P=0.002)and 3 (18.8% vs.0,P=0.005),while much fewer AS patients had Cormack-Lehane classification1 (25.0% vs.84.6%,P<0.001).A variety of difficult airway tools were used in intubation (AS group:Macintosh laryngoscope:14%,Macintosh laryngoscope with stylet:38%,visualization laryngoscope:24%,visualization stylet:10% and fiber bronchoscope:14%;non-AS group:57%,24%,12%,5% and 2%,respectively). The use of intraoperative autologous blood transfusion (33.3% vs.11.9%,P=0.041) and postoperative 24 h drainage (61.9% vs.31.0%,P=0.019) were more common in AS group. However,no statistical difference existed in the success rate of first intubation,postoperative hemoglobin,postoperative hematocrit,and postoperative hospitalization(all P>0.05). Conclusions AS patients undergoing THA have elevated preoperative inflammatory markers,with high incidence of pulmonary function abnormality and difficult airway. In consideration of high risk of surgery and anesthesia,adequate airway evaluation and optimization of perioperative management are needed to ensure the patients' safety.
authors.affiliation: 1Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;
authors.forename: Zi-jia
authors.lastname: Liu
authors.affiliation: 1Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;
authors.forename: Xue-rong
authors.initials: XR
authors.lastname: Yu
authors.affiliation: 2Department of Anesthesiology,Hebei Province Cangzhou Hospital of Integrated Traditional and Western Medicine,Cangzhou,Hebei 061001,China;
authors.forename: Yu
authors.initials: Y
authors.lastname: Dong
authors.affiliation: 3Department of Anesthesiology,Fuwai Hospital,CAMS and PUMC,Beijing 100037,China
authors.forename: Qin
authors.lastname: Zhou
authors.affiliation: 3Department of Anesthesiology,Fuwai Hospital,CAMS and PUMC,Beijing 100037,China
authors.forename: Xiao-shuang
authors.initials: XS
authors.lastname: Zou
authors.affiliation: 4Department of Orthopedics,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
authors.forename: Xi-sheng
authors.lastname: Weng
authors.affiliation: 1Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China;
authors.forename: Yu-guang
authors.lastname: Huang
mesh_terms: D000768:Anesthesia, General / Q000379:methods*; D019644:Arthroplasty, Replacement, Hip; D002097:C-Reactive Protein / Q000032:analysis; D006801:Humans; D007442:Intubation, Intratracheal; D020704:Laryngoscopes; D007902:Length of Stay; D019990:Perioperative Care; D011183:Postoperative Complications; D012189:Retrospective Studies; D013167:Spondylitis, Ankylosing / Q000601:surgery*
chemical_list: D002097:C-Reactive Protein