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Electrical Stimulation And Deep Venous Thrombosus
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Faghri P.D., Van Meerdervort
H.F., Glaser R.M., and Figoni S.F. (1997) Electrical stimulation-induced
contraction to reduce blood stasis during arthroplasty. IEEE Trans. Rehabil.
Eng 5, 62-69.
Abstract: Deep venous thrombosis and subsequent pulmonary embolism due to venous
pooling/stasis commonly occur in patients during hip and/or knee arthroplasty
(i.e., replacement). This problem may be alleviated by using techniques to
promote lower limb blood flow. Electrical stimulation-induced contractions have
been shown to activate the skeletal muscle pump, promote limb blood flow, and
may be effective for reducing venous pooling/stasis and edema. Therefore,
electrical stimulation may reduce the incidence of deep venous thrombosis (DVT)
and pulmonary embolism (PE) during and following surgery. The overall goal of
this project was to evaluate the clinical efficacy of sequential electrical
stimulation-induced leg muscle contractions on the venous blood flow during
surgery. The degree of venous pooling/stasis was monitored via electrical
impedance changes in the thorax. The changes in the patient's central
hemodynamics were then calculated. Thirty patients were recruited and randomly
assigned to either a control group (n = 15, mean age = 66.4 +/- 7.3) or
experimental group (n = 15, age = 60.7 +/- 9.7). Both groups received the
standard medical treatment for prevention of DVT (i.e., coumadin, heparin, etc.)
and compression stockings (TED, Kendall). The control group used the sequential
compression device (SCD + TED) and the experimental group used electrical
stimulation (ES + TED). Electrical stimulation was applied via surface
electrodes to the lower-limb muscles (tibialis anterior and gastrocnemius) and
upper limb muscles (quadriceps femoris and hamstrings). These muscles contracted
sequentially, using an eight-channel electrical stimulator. Four seconds of calf
(contraction/compression) were followed by 7-s of calf and thigh
(contraction/compression) interspersed by 60-s rest period during both
electrical stimulation or sequential compression device. This cycle continued
throughout the surgery (60-75 min) for both groups. At 15 min intervals, venous
return was monitored by impedance cardiograph. Physiologic responses including
ventricular stroke volume (SV), cardiac output (CO), heart rate (HR), total
peripheral resistance (TPR), as well as mean arterial pressure (MAP) were
monitored. These responses were statistically analyzed and compared throughout
the surgery within each group and between the two groups. The results show
stroke volume and cardiac output to be higher throughout surgery in the
electrical stimulation group as compared with the sequential compression device
group. The heart rate was consistently lower during electrical stimulation for
both groups. Total peripheral resistance did not change in the electrical
stimulation group; but increased in the sequential compression device group. The
data suggest that continuous electrical stimulation-induced contractions could
improve lower leg circulation by eliciting the physiologic muscle pump. This
will lead to improved venous circulation and reduction of blood stasis during
total hip and/or knee surgery. This technique may offer greater protection
against DVT and PE during surgery than the commonly used sequential compression
device
Jonsson O., Lindstrom B. (1983)
Perioperative calf-muscle stimulation for the prevention of postoperative
thromboembolic complications. Geriatric Med Today 2:86.
Lindstrom B. (1982) Prediction
and prophylaxis of postoperative thromboembolism: a comparison between
perioperative calf muscle stimulation with groups of impulses and dextran 40.
Br J Surg 69:633.
Pambianco G., Orchard T.,
Landau P. (1995) Deep vein thrombosis: prevention in stroke patients during
rehabilitation. Arch Phys Med Rehabil 76, 324-330. Abstract: Deep
vein thrombosis (DVT) and subsequent pulmonary embolism (PE) is a major source
of mortality and morbidity in stroke patients. This study was designed to
determine the effectiveness of different prophylactic treatments in the
prevention of DVT after a stroke in patients undergoing rehabilitation. An
additional objective was the identification of risk factors for DVT in stroke
patients. Three hundred and sixty patients, over a 3-year period, were randomly
assigned to one of four groups: adjusted dose heparin, intermittent pneumatic
compression (IPC), functional electrical stimulation (FES), or control. There
was no significant difference in the development of DVT by treatment group.
Patients with DVT on admission (prevalent, n=61) were compared with the study
patients (360). Time interval (from stroke to admission) and lactic
dehydrogenase (LDH) concentration were significant risk factors as well as
predictors, for development of DVT (p<.000). These results suggest that the
longer a patient remains without DVT prophylaxis after a stroke, the greater the
risk of developing DVT and this supports early prophylaxis before
rehabilitation.
Katz R.T., Green D., Sullivan
T., Yarkony G. (1987) Functional electrical stimulation to enhance systemic
fibrinolytic activity in spinal cord injury patients. Arch Phys Med Rehabil
68:423-426.
Merli G.J., Crabbe S., Paluzzi
R.G., and Fritz D. (1993) Etiology, incidence, and prevention of deep vein
thrombosis in acute spinal cord
injury. Arch. Phys. Med. Rehabil. 74, 1199-1205.
Abstract: This article provides a critical review of the literature on the
etiology, incidence, and prevention of deep-vein thrombosis in acute spinal cord
injured patients. Stasis and hypercoagulability are the two major factors
contributing to the development of thrombosis in this patient population. This
has been supported by studies that demonstrate an impaired venous return from
the lower extremities and abnormal coagulation factors, which predispose to
thrombogenesis. The incidence of deep vein thrombosis secondary to the above
etiologies varies from 49% to 100% in the first 12 weeks with the first 2 weeks
having the highest rate following acute injury. This high rate of complication
has led to numerous studies to identify the most effective regimens of
prophylaxis. Studies using noninvasive testing and venography in acute spinal
cord injury have supported two approaches for preventing deep- vein thrombosis.
Single agent pharmacologic therapy with adjusted dose heparin is effective but
does carry some risk of bleeding. Combination therapy with external pneumatic
compression sleeves plus either aspirin/dipyridamole or low-dose heparin and
electrical stimulation plus low-dose heparin have significantly reduced the
incidence of deep vein thrombosis. The duration of prophylaxis with the above
modalities has varied between 8 and 12 weeks following acute injury. Further
large scale studies are required in this high-risk population to better
delineate the incidence of deep vein thrombosis and pulmonary embolism, to
identify the best modalities, and to define the duration of treatment for the
prevention of these complications.(ABSTRACT TRUNCATED AT 250 WORDS)
Patel M.I., Hardman D.T.,
Nicholls D., Fisher C.M., and Appleberg M. (1996) The incidence of deep venous
thrombosis after laparoscopic cholecystectomy. Med. J. Aust. 164, 652-4,
656 .
Abstract: OBJECTIVE: To determine the incidence of deep venous thrombosis (DVT)
after laparoscopic cholecystectomy. DESIGN: Prospective cross-sectional
analysis, with a one-month follow-up, conducted in 1994. SETTING: University
teaching hospital. SUBJECTS: 20 patients undergoing elective or urgent
laparoscopic cholecystectomy, consecutively recruited. INTERVENTIONS: Patients
received thromboprophylaxis according to the normal practice of the attending
surgeon and underwent laparoscopic cholecystectomy. A venous duplex scan was
performed before the operation and on Day 1, 7 and 30 after the operation. MAIN
OUTCOME MEASURE: The presence of postoperative DVT. RESULTS: All patients were
given graduated compression stockings to wear and 16 received electrical
stimulation of the calf during the operation. Only 16 patients received
pharmacological thromboprophylaxis before the operation, but all patients
received this after the operation. The median duration of pneumoperitoneum was
80 minutes (40-160 minutes). Eleven of 19 patients completing all the required
scans developed venous thrombosis (incidence, 55%); in three the thromboses
involved major axial veins. In one patient the Day 7 and Day 30 scans were not
performed, but the Day 1 scan was negative. Seven of the 11 thromboses were
detected on the Day 1 scan. None of the DVTs were suspected clinically.
CONCLUSIONS: This extremely high incidence of venous thrombosis correlates with
the haemodynamic changes which occur in the venous system during
pneumoperitoneum. Laparoscopic cholecystectomy should not be considered a
procedure with a low risk of DVT, and further studies are needed to determine
optimal DVT prophylaxis for laparoscopic surgery
Rosenberg I.L., Evans M.,
Pollack A.V. (1975) Prophylaxis of post-operative leg vein thrombosis by low
dose subcutaneous heparin or perioperative calf muscle stimulation: a controlled
clinical trial. Br Med J 1:649.
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