Background and objective: Hypotension and bradycardia are the most common hemodynamic disorders and side effects of spinal anesthesia (SA) on the cardiovascular system. SA-induced sympathetic denervation causes peripheral vasodilatation and redistribution of central blood volume that may lead to decreased venous return to the heart. The aim of the study was to evaluate the changes of inferior vena cava collapsibility index (IVC-CI) during SA in spontaneously breathing patients during elective knee joint replacement surgery to prognose manifestation of intraoperative hypotension and bradycardia. Materials and methods: 60 patients (American Society of Anesthesiologists (ASA) physical status I or II, no clinically significant cardiovascular pathology) of both sexes undergoing elective knee joint replacement surgery under SA were included in the prospective study. Inspiratory and expiratory inferior vena cava (IVCin, IVCex) diameters were measured using an ultrasound device in supine position before and immediately after SA, then 15 min, 30 min, and 45 min after SA was performed. The heart rate, along with systolic, diastolic, and mean arterial blood pressures were collected. The parameters were measured at the baseline and at the next four time points. Results: There were no significant changes in IVCin, IVCex, and IVC-CI compared to baseline and other time point measurements in hypotensive versus nonhypotensive and bradycardic versus nonbradycardic patients (p > 0.05). Changes in IVC diameter do not prognose hypotension and/or bradycardia during SA: the area under the curve (AUC) of the receiver operating characteristic (ROC) curve for IVC-CI at all measuring points was 0.05. Conclusions: Reduction in IVC diameters and increase in IVC-CI do not predict hypotension and bradycardia during SA in spontaneously breathing patients undergoing elective knee joint replacement surgery.

Background: Postoperative cognitive dysfunction (POCD) commonly affects elderly patients, but the impact of BIS-guided sedation during elective orthopedic surgery under spinal anesthesia remains unclear. The aim was to compare BIS-controlled versus standard clinically guided sedation on POCD in elderly patients undergoing elective knee arthroplasty. Methods: This was a prospective, patient- and outcome assessor-blinded, randomized controlled clinical study. Participants were randomized into two groups: BIS-targeted sedation (BIS group > 70) and standard clinical sedation (non-BIS group). All patients received the same anesthetic and analgesic. The primary outcome was the change in cognitive function over time. Cognitive function was assessed four times using the Addenbrooke’s Cognitive Examination–Revised (ACE-R) questionnaire. Higher scores indicate better cognitive performance. The emotional status was evaluated two times using the Hospital Anxiety and Depression Scale (HADS) . Results: Ninety-two patients (46 per group) were included in the final analysis. No statistically significant differences in total ACE-R score were found between the two groups at any time point ( p > 0.05). Within the BIS group, total ACE-R scores were significantly higher on postoperative day (POD) 90 than preoperatively (PO) (87 (65–96) vs. 92 (70–98), p = 0.007). In the non-BIS group, total ACE-R scores increased significantly at several time points: from PO to 30 POD (87 (48–96) vs. 90.5 (40–98), p = 0.007), from PO to 90 POD (87 (48–96) vs. (91 (40–99), p < 0.001), and from 2 to 30 POD (88 (45–98) vs. 90.5 (40–98), p = 0.005). Significant decline in the number of patients experiencing probable anxiety at 30 POD compared with PO in both groups (BIS 28.3% to 2.2%, p = 0.004; non-BIS 32.6% to 8.7%, p = 0.015). Conclusions: This study did not demonstrate superiority of BIS-controlled sedation compared to clinically guided sedation with regard to cognitive outcomes. Further studies are needed. Trial registration: ClinicalTrials.gov (NCT06241859, January 28, 2024)

Background and Objectives: Benzodiazepines (BZDs) are among the most widely prescribed psychotropic drugs globally, and Lithuania is no exception. People with osteoarthritis (OA) often experience chronic pain before arthroplasty, which can cause insomnia, anxiety, and mood disturbances, sometimes leading to BZDs or Z drug prescriptions. The use of these medications, particularly over the long term, may adversely affect cognitive function and increase the risk of falls. Cognitive and psychomotor impairments may hinder rehabilitation, delay mobilization, and reduce quality of life after elective arthroplasty. The aim of this study was to evaluate the prevalence of psychotropic drugs among Lithuanian elderly patients undergoing elective arthroplasty. Materials and Methods: The study, approved by the Regional Bioethics Committee (No. BE-2-53), was conducted at the Department of Anesthesiology, Hospital of the Lithuanian University of Health Sciences Kaunas Clinics. Data on psychotropic medication use, underlying conditions, and treatment duration were obtained from the Hospital’s Information System. Participants were adults aged ≥65 years scheduled for elective arthroplasty with ASA physical status I–III. Data were presented as frequencies (n) and percentages (%). Results: A total of 362 participants were enrolled, of whom 223 (61.6%) used psychotropic medications. Most (63.2%) took BZDs, mainly bromazepam (29.1%) and alprazolam (27.4%). The leading indication was sleep disorders (38.1%), most often treated with alprazolam (34%), followed by anxiety disorders (20.2%), typically managed with bromazepam (24.8%). 99% of participants had been receiving BZDs for more than four weeks. Conclusions: Over half of Lithuanian OA patients undergoing elective arthroplasty used BZDs, underscoring the need for cautious, evidence-based prescribing – particularly in older adults. Regular medication reviews, adherence to national and EU guidelines, and greater use of non-pharmacological therapies are advised. Future research should examine drivers of chronic BZDs use and evaluate deprescribing and alternative treatments for safer, more sustainable care.