The aim is to show our experience in anesthesia of patients with osteogenesis imperfecta (OI) who have undergone orthopedic surgical procedures. This is a retrospective analysis of OI patients ...treated at our Department from 1980 to 2012. We analyzed demographics, comorbidities, preoperative characteristics, anesthesia types, anesthetics and intraoperative and postoperative complications. In the given period, 26 OI patients were treated, using 103 surgeries, and 103 anesthesia procedures. Most procedures, a total of 68, were used in children aged 0-10 years. According to the diagnosis, OI type III was mostly encountered. The rating of the American Society of Anesthesiologist (ASA) physical status was II in most cases, a total of 99. General anesthesia was used in 89 cases, and regional anesthesia in 14. Fourteen intraoperative complications were seen, mostly difficult intubation, and six postoperative cardiovascular instability cases. With careful preparation, and knowledge of pitfalls, anesthesia in these patients should be a safe procedure.
Immobilization with external fixation bridging the knee joint in extension is frequently used after sustaining a war injury to the region of the knee joint with femoral and tibial bone fractures. ...Immobilization of the knee with plaster splints is performed in the same position. This usually prolonged treatment results in extension contractures of the knee joint. From June 1991 until March 1994, 54 patients with extension contractures of the knee caused by war wounds were treated at the Department of Orthopedics, Zagreb University Hospital Center, in Zagreb, Croatia. Results of surgical treatment of 44 patients are presented. The operative procedure consisted of extensive intra- and extra-articular adhesiolysis of the knee. The control group included 30 patients with knee contractures caused by injuries sustained in car crashes or secondary to previous operative procedures. The mean duration of immobilization was 5 months and 6 days. The mean preoperative knee motion amplitude ranged from 5 degrees in extension to 38 degrees in flexion. The mean postoperative knee motion was 98 degrees (range, 2 to 110 degrees). Treatment results did not depend on either duration of preoperative immobilization of the knee or previous infection in the region of injury. Previous knee joint bridging with an external fixator had no impact on the results of extension contracture treatment. Adequate intra- and extra-articular adhesiolysis with appropriate long-term postoperative rehabilitation is essential for the success of the operative treatment for knee joint contracture.
Postoperacijski delirij ili stanje akutne konfuzije je često nakon kirurških zahvata, a učestalost ovisi o vrsti operacije i kliničkim osobitostima bolesnika. Utvrđeno je da je delirij čest kod ...bolesnika starije životne dobi, sa simptomima demencije, funkcionalnim poremećajima, nikotinizmom, značajnim komorbiditetom, patološkim vrijednostima elektrolita (K, Na), glukoze i albumina (<4.9 g/dl) te psihopatološkim simptomima. (npr. depresijom). Dokazano je da je čest kod operacijskih zahvata s velikim perioperacijskim stresom, a drugi rizici uključuju značajno krvarenje, nizak postoperacijski hematokrit, respiracijske poremećaje, hipotenziju i dr. Deliriju mogu pridonijeti i lijekovi koji se primjenjuju perioperacijski kao inhalacijski anestetici i opioidni analgetici. Upotreba tih lijekova i perioperacijski stres su manji pri izvođenju kirurških zahvata u regionalnoj anesteziji te su provedene studije u kojima se uspoređuje učestalost delirija pri općoj i regionalnoj anesteziji. Dosadašnje studije su pokazale manju učestalost delirija pri regionalnoj anesteziji, ali razlika nije statistička značajna. Nedostatak većine tih studija je da su retrospektivne, nerandomizirane s malim brojem bolesnika, te je potrebno provesti prospektivne studije koje će ciljano analizirati postoperacijski delirij i tip anestezije te će se tek tada moći donijeti definitivni zaključak o utjecaju tipa anestezije na učestalost postoperacijskog delirija.
Purpose
During total knee arthroplasty (TKA) blood loss can be significant and in spite of all techniques for reducing blood loss there is still a significant possibility for blood transfusions. For ...blood loss management during TKA, pre-operative autologous blood donation (PABD) is still a standard of care. In this prospective randomised study we have evaluated the efficacy of PABD in patients undergoing TKA to answer the question whether there is any need for autologous blood donations during TKA and, if yes, for which group of patients.
Methods
Patients were randomised to three groups. In group 1 patients did not donate autologous blood, in group 2 patients donated 1 dose 72 hours prior to TKA and in group 3 patients donated autologous blood 14 days prior to TKA. In all patients haemoglobin, haematocrit, thrombocyte and reticulocyte values, iron concentrations (Fe, unsaturated iron binding capacity, total iron binding capacity), activated partial thromboplastin time, prothrombin time, and intra-operative and post-operative blood loss were measured and compared.
Results
With PABD there was no reduction in allogeneic blood transfusions and a large number of taken doses of autologous blood was discarded, which significantly increased the cost of treatment for these patients. For patients undergoing TKA, PABD can provoke iatrogenic anaemia and thereby increase the likelihood of the need for allogeneic blood transfusion.
Conclusions
Results of our study showed that PABD in non-anaemic patients is not justified and is not economically feasible.
Introduction
Metamizole use has been limited because of its risk of agranulocytosis. However, more recent literature seems to support its safety. This prospective, randomised, double-blind study was ...conducted to compare the analgesic effects of intravenous metamizole or intravenous paracetamol in combination with morphine PCA during the first 24 h following total hip arthroplasty.
Materials and methods
One hundred ten consecutive patients were selected for study. The two study groups were (A) metamizole, (B) paracetamol. Postoperative pain therapy was provided by Morphine PCA pump. In the first treatment group (A group), all patients received intravenous metamizole 1.5 g every 8 h during the first 24 postoperative hours. In the second treatment group (B group), all patients received intravenous paracetamol 1 g every 8 h during the first 24 postoperative hours. Postoperative pain intensity was measured 1, 2, 3, 4, 6, 8, 10, 14, 18, 22 h after the end of surgery by a VAS.
Results
Statistically significant differences in VAS pain values favoring metamizole were reported at 6-h (
p
= 0.038), 8-h (
p
= 0.036), 14-h (
p
= 0.011), 18-h (
p
< 0.001) and 22-h (
p
= 0.025) post-baseline. Mean cumulative pain values were 17.9 for metamizole and 30.6 for paracetamol.
Conclusions
In this study, we have also shown excellent efficacy of paracetamol and metamizole combined with opioids, but metamizole proved to be a better analgesic than paracetamol. It is also necessary to mention the financial aspect considering that intravenous paracetamol is about ten times more expensive than an equivalent analgesic doses of intravenous metamizole.
Purpose
Our aim was to evaluate the effectiveness of two different dosing regimens of human recombinant erythropoietin (rHu-EPO) for preoperative autologous blood collection in patients undergoing ...total hip arthroplasty (THA).
Methods
Prospective randomised trials in which erythropoietin 15,000 IU was administered intravenously twice a week or 30,000 IU once a week (total 90,000 IU) combined with ferrous II sulphate (Ferro-Gradumet 2) orally and compared with Ferro-Gradumet 2 alone.
Results
Although different dosing regimens of rHu-EPO administration during preoperative autologous blood donation have similar effects on the collection of two units of autologous blood, preoperative haemoglobin level and perioperative allogenic blood transfusion, a once weekly dose regimen of rHu-EPO was more convenient (although not statistically significantly) for patients.
Conclusion
We recommend the more practical and comfortable but yet highly effective therapeutic regimen with a single weekly intravenous administration of rHu-EPO for patients scheduled for THA.
Preoperative donation of blood for autologous transfusion has become a routine practice for patients who are scheduled to have an ortopaedic procedure. The purpose of this retrospective study was to ...evaluate the effect of preoperative autologous donation on reduction of allogeneic blood transfusion in patients undergoing revision hip arthroplasty. Data of 289 patients who had had a revision total hip arthroplasty during sixty-six-month period were evaluated retrospectively. One hundred and thirty-eight patients donated 1 or two units of autologous blood (47.8%), and 151 patients (52.2%) did not. Preoperative autologous blood reduced allogeneic blood transfusion in patients who had a revision of femoral component only or revision of acetabular component only. Two predonated autologous units and basic hemoglobin level >150 g/L reduced allogeneic blood transfusion in patients who had revision of acetabular and femoral component. All patients who had revision of acetabular and femoral component and had basic hemoglobin level <120 g/L, required additional allogeneic blood transfusion despite predonation blood.
Autotransfusion is widely used after total hip arthroplasty (THA), but there are concerns about damage of red blood cells (RBCs) collected after surgery. In this study, we wanted to determine the ...damage and survival of RBCs salvaged after cemented THA and after uncemented THA and to compare the results. In this prospective study of 60 patients-30 who underwent cemented THA and 30 who underwent uncemented THA-postoperative autotransfusion systems (BIODREN; B.E.R.C.O., Modena, Italy) were used. Levels of potassium and free hemoglobin in the postoperative blood samples were analyzed. Before transfusion, salvaged RBCs were labeled with radioactive chromium-51, and their survival was measured. In blood salvaged after cemented THA, medium potassium level was 4.1 mmol/L (range, 3.2-5.6 mmol/L), and mean free hemoglobin level was 327 mg% (range, 120-410 mg%). In blood salvaged after uncemented THA, mean potassium level was 4.2 mmol/L (range, 3.1-5.5 mmol/L), and mean free hemoglobin level was 296 mg% (range, 130-402 mg%). In the cemented group, RBC survival was 73% at 48 hours after transfusion (range, 61%-79%), and mean time from 100% activity to 50% activity was 21 days (range, 14.2-28.2 days). In the uncemented group, RBC survival was 75% at 48 hours after transfusion (range, 68%-82%), and mean time from 100% to 50% activity of radio-labeled RBCs was 22 days (range, 16.2-29.4 days). There were no statistically significant differences in potassium levels, free hemoglobin levels, or RBC survival between the cemented and uncemented groups. Blood salvaged after surgery was not significantly damaged. Our study results confirmed that washing blood collected after surgery is not necessary. Not washing this blood is safe and decreases allogeneic transfusion in orthopedic procedures.
Prednji dio čahure zgloba kuka nerviraju n. femoralis i n. obturatorius, dok stražnji dio čahure inervira n. musculi quadratus femoris i povremeno n. glutealis superior (posterolateralni dio) i n. ...ischiadicus (posterosuperiorni dio). Jedna od mogućnosti za primjenu regionalne anestezije u kirurgiji zgloba kuka je blok odjeljka fascije iliace (FICB), koji zahvaća živce bitne za inervaciju kuka te senzornu inervaciju bedra – n. femoralis, n.obturatorius i n. cutaneus femoris lateralis. FICB se može izvesti relativno jednostavno i predstavlja dobru opciju za zbrinjavanje fraktura kuka u hitnim situacijama. Dokazano je kako smanjuje upotrebu morfija preoperativno u pacijenata s frakturom vrata femura, a može biti indicirani za artroplastiku kuka, artroskopije kuka te sanaciju opeklina u regiji bedra. Quadratus Lumborum blok (QLB ) spada u blokove stražnjeg abdominalnog zida te se provodi isključivo pod kontrolom ultrazvuka. Još uvijek nije razjašnjen točan mehanizam njegovog djelovanja. Dokazano je kako prednji QLB dovodi do smanjenja trajanja boravka u bolnici i smanjenja upotrebe opioida nakon operacija kuka. Također, pokazao se kao uspješnija metoda perioperativne analgezije u bolesnika u kojih se provodi zahvat na kuku ili proksimalnom femuru u usporedbi sa standardnom intravenskom analgezijom, te omogućuje ranu mobilizaciju pacijenata, što smanjuje pojavnost duboke venske tromboze i tromboembolijskih komplikacija. S druge strane, neki živčani ogranci koji sudjeluju u inervaciji zgloba kuka nisu zahvaćeni s QLB , što također treba uzeti u obzir. QLB se pokazao kao potencijalna opcija za anesteziju u kirurgiji kuka, no tek se treba dokazati njegova pouzdanost.
Background and Purpose: there are many advantages of regional anaesthesia for orthopedic procedures. In perioperative period orthopedic patients received thromboprophylaxis with low mollecular weight ...heparins (LMWH) or new anticoagulated drugs. The most popular new drugs for thromboprophylaxis in patients with joint replacement are fondaparinux, rivaroxaban and dabigatran. After introduction of LMWH for thromboprophylaxis serious complications including spinal hematom have been reported. It is very important perform regional anaesthesia in patients receiving anticoagulated drugs according to recommendations. These article reviews the actual recommendations and the current status and management
of these new drugs.
Recent findings: recent studies are outlined that the risk of spinal
hematoma after neuraxial anaesthesia may be higher than estimated. The use of new anticoagulant drugs should take into account the pharmacological profile of each drug to safely perform regional anaesthesia, mainly the time to reach peak plasma level and half-life.
Conclusion: When new anticoagulant drugs are used for thromboprophylaxis in orthopedic surgery, the performance of neuraxial anaesthesia is safe method if is based on the pharmacology of drugs. All methods of regional anaesthesia should be perfomed according to accepted recommendations
regarding the time of block and the time of drug administration.
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