Cardiac and Renal Biomarkers in Arthroplasty Surgery

Effect of Spinal Versus General Anesthesia on Cardiac and Renal Biomarker Levels in Hip and Knee Arthroplasty Surgery

The investigators will compare the effect of spinal anesthesia to general anesthesia on the level of high sensitivity cardiac biomarkers in patients undergoing hip or knee arthroplasty. The investigators will also measure renal biomarkers in urine to evaluate kidney injury in the postoperative period.

The study will enroll a total of 140 adult patients undergoing hip or knee arthroplasty (equal numbers) at Barnes-Jewish-Hospital. These procedures will be randomized with 50% of the procedures performed under spinal anesthesia and 50% procedures performed under general anesthesia. Patients randomized to spinal anesthesia will receive sedation with dexmedetomidine up to 1 mcg/kg/min, and then add small dose of propofol (up to 50 mcg/kg/min) and fentanyl at the discretion of the anesthesia provider the Richmond Agitation and Sedation Scale (RASS) -2 to -3. Headphones to play music will be offered to patients undergoing spinal anesthesia to minimize the noise generated from the surgical intervention. The investigators will study the effect of spinal anesthesia versus general anesthesia on cardiac biomarker levels in hip and knee arthroplasty population (levels of Hs-cTnI postoperatively compared to baseline values) Also, the incidence of postoperative renal injury using investigational renal biomarkers, Myo-Inositol Oxygenase (MIOX) and Nephrocheck

cardiovascular effect measured by changes in levels of Hs-cTnI postoperatively compared to baseline values

cardiovascular effect measured by changes in levels of Hs-cTnI postoperatively compared to baseline values

cardiovascular effect measured by changes in levels of Hs-cTnI postoperatively compared to baseline values

cardiovascular effect measured by changes in levels of Hs-cTnI postoperatively compared to baseline values

cardiovascular effect measured by changes in levels of Hs-cTnI postoperatively compared to baseline values

cardiovascular effect measured by changes in levels of Hs-cTnI postoperatively compared to baseline values

cardiovascular effect measured by changes in levels of Hs-cTnI postoperatively compared to baseline values

MIOX, Kidney Injury Molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL) and Nephrocheck measured in ng/ml

MIOX, Kidney Injury Molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL) and Nephrocheck measured in ng/ml

Difference renal biomarkers levels according to anesthesia groups - Pain scores and the incidence of intraoperative hypotension

Difference renal biomarkers levels according to anesthesia groups - Pain scores and the incidence of intraoperative hypotension

Difference renal biomarkers levels according to anesthesia groups - Pain medication consumption and the incidence of intraoperative hypotension

Difference renal biomarkers levels according to anesthesia groups - Pain medication consumption and the incidence of intraoperative hypotension

Difference in cardiac biomarker levels according to surgical groups - Pain scores, pain medications consumption and the incidence of intraoperative hypotension

Difference in cardiac biomarker levels according to surgical groups - Pain scores, pain medications consumption and the incidence of intraoperative hypotension

Difference in cardiac biomarker levels according to surgical groups - Pain scores and the incidence of intraoperative hypotension

Difference in renal biomarker levels according to surgical groups - Pain medication consumption and the incidence of intraoperative hypotension

Difference in renal biomarker levels according to surgical groups - Pain medication consumption and the incidence of intraoperative hypotension

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on renal biomarkers - Pain scores and the incidence of intraoperative hypotension

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on renal biomarkers - Pain scores and the incidence of intraoperative hypotension

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on renal biomarkers - Pain medication consumption and the incidence of intraoperative hypotension

The effect of nonsteroidal anti-inflammatory drugs (NSAIDs) on renal biomarkers - Pain medication consumption and the incidence of intraoperative hypotension

Inclusion Criteria: Adult patients, age 60 years or older Ability to provide informed consent American Society of Anesthesiologists (ASA) classification II or higher Exclusion Criteria: Hip fracture procedures Contraindications to neuraxial anesthesia per The American Society of Regional Anesthesia (ASRA) guidelines Procedure anticipated duration is longer than expected planned spinal anesthesia duration

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