Perioperatively Acquired Weakness. (February 2020)

• Record Type: Journal Article
• Authors: Lachmann, Gunnar; Mörgeli, Rudolf; Kuenz, Sophia; Piper, Sophie K.; Spies, Claudia; Kurpanik, Maryam; Weber-Carstens, Steffen; Wollersheim, Tobias
• Is Part Of: Anesthesia & analgesia. Volume 130:Number 2(2020)
• Publication Date: 2020-02
• Subjects: Anesthesiology -- Periodicals; Anesthesia; Anesthesiology; Analgesia; Analgesics; Anesthesiology -- Periodicals; 617.9605
• DOI: 10.1213/ANE.0000000000004068
• Languages: English
• ISSNs: 0003-2999

Abstract

Abstract : BACKGROUND: Skeletal muscle failure in critical illness (intensive care unit-acquired weakness) is a well-known complication developing early during intensive care unit stay. However, muscle weakness during the perioperative setting has not yet been investigated. METHODS: We performed a subgroup investigation of a prospective observational trial to investigate perioperative muscle weakness. Eighty-nine patients aged 65 years or older were assessed for handgrip strength preoperatively, on the first postoperative day, at intensive care unit discharge, at hospital discharge, and at 3-month follow-up. Functional status was evaluated perioperatively via Barthel index, instrumental activities of daily living, Timed Up and Go test, and functional independence measure. After exclusion of patients with intensive care unit-acquired weakness or intensive care unit stay of ≥72 hours, 59 patients were included into our analyses. Of these, 14 patients had additional pulmonary function tests preoperatively and on postoperative day 1. Blood glucose was measured intraoperatively every 20 minutes. RESULTS: Handgrip strength significantly decreased after surgery on postoperative day 1 by 16.4% ( P < .001). Postoperative pulmonary function significantly decreased by 13.1% for vital capacity ( P = .022) and 12.6% for forced expiratory volume in 1 second ( P = .001) on postoperative day 1. Handgrip strength remained significantly reduced at hospital discharge ( P = .016) and at the 3-month follow-up ( P = .012). Perioperative glucose levels showed no statistically significant impact on muscle weakness. Instrumental activities of daily living ( P < .001) and functional independence measure ( P < .001) were decreased at hospital discharge, while instrumental activities of daily living remained decreased at the 3-month follow-up ( P = .026) compared to preoperative assessments. CONCLUSIONS: Perioperatively acquired weakness occurred, indicated by a postoperatively decreased handgrip strength, decreased respiratory muscle function, and impaired functional status, which partly remained up to 3 months.