Title : Syncopal/ Presyncopal episodes in orthopedic surgery patients in the postoperative orthopedic patient
Abstract:
Introduction: Syncopal/ Presyncopal episodes are occurrences of dizziness or lightheadedness followed by a rapid and complete recovery with or without loss of consciousness. However, these symptoms can sometimes be confused with cardiac events and to ensure patient safety, code green or rapid response is called. These patients, in general, will recover quickly with minimal treatment but may endure falls or injuries; thus, jeopardizing patient outcomes, increase length of stay, and cost. Research suggests that the main causes of syncopal/ pre-syncopal episodes include vasovagal syncope, cardiac arrhythmias, and orthostatic hypotension. In the intensive care unit, orthopedic surgical patients have multiple underlying risks for syncopal and pre-syncopal episodes including blood or fluid loss, blood pressure medications, pain medications, among other reasons. It is essential to determine the causes of syncope and patients who will be at high risk so that the episodes can be prevented, and patient safety can be warranted.
Objectives: Due to increased number of syncopal/ pre-syncopal episodes in the hospital, the purpose of this study is to examine the common causes of syncopal/ presyncopal episodes in postoperative orthopedic inpatients admitted to the hospital.
Methods: A retrospective chart review for total knee, total hip arthroplasty and various spine surgery patients admitted to the hospital was conducted. Patient characteristics, past syncopal history, past medical history, blood loss during surgery, current medications, and blood pressure readings were measured for all patients who experienced syncopal/ presyncopal episodes in 2019 and 2020. These patients were identified from the records of the patients who had code green or rapid responses.
Results: A total of 143 syncopal/ presyncopal episodes with patients aged 47 to 85 years old (Mean: 66 ± 8) with spinal and general anesthesia were examined. More than 50% of patients were on either a betablocker for blood pressure control or an opioid for pain management. Most of the episodes were related to ambulating patients to the bathroom, commode, or chair. Many patients had loss of consciousness, lightheadedness, and diaphoresis. A significant number of patients had around 20 mm Hg decrease in their blood pressure between last recorded blood pressure and during code blood pressure readings. For the majority of the patients, the ambulation that led to the syncopal/ presyncopal episode was not the first ambulation.
Conclusion: Identifying patients at risk for syncopal/ presyncopal episodes is essential in order to promote patient safety. Findings from this study suggest that the majority of patients experiencing syncopal/ presyncopal episodes have experienced orthostatic hypotension. The findings necessitate identifying necessary interventions to identify patients at risk for these episodes and introduce interventions that prevent syncopal/ presyncopal episodes such as orthostatic training and diligent blood pressure monitoring before ambulation.
