Journal of Anesthesia

, Volume 27, Issue 6, pp 895–900 | Cite as

Orthostatic intolerance during early mobilization following video-assisted thoracic surgery

  • Toshiyuki Mizota
  • Yoshika Iwata
  • Hiroki Daijo
  • Tomohiro Koyama
  • Tomoharu Tanaka
  • Kazuhiko Fukuda
Original Article



Early postoperative mobilization is crucial for early ambulation to reduce postoperative pulmonary complications after lung resection. However, orthostatic intolerance (OI) may delay patient recovery, leading to complications. It is therefore important to understand the prevalence of and predisposing factors for OI following video-assisted thoracic surgery (VATS), which have not been established. This study evaluated the incidence of OI, impact of OI on delayed ambulation, and predisposing factors associated with OI in patients after VATS.


This retrospective cohort study consecutively analyzed data from 236 patients who underwent VATS. The primary outcome was defined as OI with symptoms associated with ambulatory challenge on postoperative day 1 (POD1), including dizziness, nausea and vomiting, feeling hot, blurred vision, or transient syncope. Multivariate logistic regression was performed to identify independent factors associated with OI.


Of the 236 patients, 35.2 % (83) experienced OI; 45.8 % of these could not ambulate at POD1, compared with 15.7 % of patients without OI (P < 0.001). Factors independently associated with OI included advanced age [odds ratio 2.83 (1.46–5.58); P = 0.002], female gender [odds ratio 2.40 (1.31–4.46); P = 0.004], and postoperative opioid use [odds ratio 2.61 (1.23–5.77); P = 0.012]. Use of thoracic epidural anesthesia was not independently associated with OI [odds ratio 0.72 (0.38–1.37); P = 0.318].


Postoperative OI was common in patients after VATS and significantly associated with delayed ambulation. Advanced age, female gender, and postoperative opioid use were identified as independent predisposing factors for OI.


Orthostatic intolerance Video-assisted thoracic surgery Opioids Ambulation Analgesia 



The authors thank Enago ( for the English language review.


  1. 1.
    Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997;78:606–17.PubMedCrossRefGoogle Scholar
  2. 2.
    Khoo CK, Vickery CJ, Forsyth N, Vinall NS, Eyre-Brook IA. A prospective randomized controlled trial of multimodal perioperative management protocol in patients undergoing elective colorectal resection for cancer. Ann Surg. 2007;245:867–72.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Wind J, Polle SW, Fung Kon Jin PH, Dejong CH, von Meyenfeldt MF, Ubbink DT, Gouma DJ, Bemelman WA, Laparoscopy and/or Fast Track Multimodal Management Versus Standard Care (LAFA) Study Group, Enhanced Recovery after Surgery (ERAS) Group. Systematic review of enhanced recovery programmes in colonic surgery. Br J Surg. 2006;93:800–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Grubb BP. Neurocardiogenic syncope and related disorders of orthostatic intolerance. Circulation. 2005;111:2997–3006.PubMedCrossRefGoogle Scholar
  5. 5.
    Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89:1352–9.PubMedGoogle Scholar
  6. 6.
    Bundgaard-Nielsen M, Jørgensen CC, Jørgensen TB, Ruhnau B, Secher NH, Kehlet H. Orthostatic intolerance and the cardiovascular response to early postoperative mobilization. Br J Anaesth. 2009;102:756–62.PubMedCrossRefGoogle Scholar
  7. 7.
    Jans O, Bundgaard-Nielsen M, Solgaard S, Johansson PI, Kehlet H. Orthostatic intolerance during early mobilization after fast-track hip arthroplasty. Br J Anaesth. 2012;108:436–43.PubMedCrossRefGoogle Scholar
  8. 8.
    Iwata Y, Mizota Y, Mizota T, Koyama T, Shichino T. Postoperative continuous intravenous infusion of fentanyl is associated with the development of orthostatic intolerance and delayed ambulation in patients after gynecologic laparoscopic surgery. J Anesth. 2012;26:503–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Auriant I, Jallot A, Hervé P, Cerrina J, Le Roy Ladurie F, Fournier JL, Lescot B, Parquin F. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Am J Respir Crit Care Med. 2001;164:1231–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Muehling BM, Halter GL, Schelzig H, Meierhenrich R, Steffen P, Sunder-Plassmann L, Orend KH. Reduction of postoperative pulmonary complications after lung surgery using a fast track clinical pathway. Eur J Cardiothorac Surg. 2008;34:174–80.PubMedCrossRefGoogle Scholar
  11. 11.
    Joshi GP, Bonnet F, Shah R, Wilkinson RC, Camu F, Fischer B, Neugebauer EA, Rawal N, Schug SA, Simanski C, Kehlet H. A systematic review of randomized trials evaluating regional techniques for postthoracotomy analgesia. Anesth Analg. 2008;107:1026–40.PubMedCrossRefGoogle Scholar
  12. 12.
    Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102:1884–98.PubMedCrossRefGoogle Scholar
  13. 13.
    de Leon-Casasola OA, Lema MJ. Postoperative epidural opioid analgesia: what are the choices? Anesth Analg. 1996;83:867–75.PubMedGoogle Scholar
  14. 14.
    Tschernko EM, Hofer S, Bieglmayer C, Wisser W, Haider W. Early postoperative stress: video-assisted wedge resection/lobectomy vs. conventional axillary thoracotomy. Chest. 1996;109:1636–42.PubMedCrossRefGoogle Scholar
  15. 15.
    Perttunen K, Nilsson E, Kalso E. i.v. diclofenac and ketorolac for pain after thoracoscopic surgery. Br J Anaesth. 1999;82:221–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Hill SE, Keller RA, Stafford-Smith M, Grichnik K, White WD, D’Amico TA, Newman MF. Efficacy of single-dose, multilevel paravertebral nerve blockade for analgesia after thoracoscopic procedures. Anesthesiology. 2006;104:1047–53.PubMedCrossRefGoogle Scholar
  17. 17.
    Fiorelli A, Vicidomini G, Laperuta P, Busiello L, Perrone A, Napolitano F, Messina G, Santini M. Pre-emptive local analgesia in video-assisted thoracic surgery sympathectomy. Eur J Cardiothorac Surg. 2010;37:588–93.PubMedCrossRefGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2013

Authors and Affiliations

  • Toshiyuki Mizota
    • 1
  • Yoshika Iwata
    • 1
  • Hiroki Daijo
    • 1
  • Tomohiro Koyama
    • 1
  • Tomoharu Tanaka
    • 1
  • Kazuhiko Fukuda
    • 1
  1. 1.Department of AnesthesiaKyoto University HospitalKyotoJapan

Personalised recommendations