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  • Image not available.Clinical manifestations of bone cement implantation syndrome include hypoxia (increased pulmonary shunt), hypotension, dysrhythmias (including heart block and sinus arrest), pulmonary hypertension (increased pulmonary vascular resistance), and decreased cardiac output.
  • Image not available.Pneumatic tourniquets are often used in knee arthroscopic surgeries because they create a bloodless field, which greatly facilitates the procedure. However, tourniquets are associated with potential problems of their own, including hemodynamic changes, pain, metabolic alterations, arterial thromboembolus, and even pulmonary embolism.
  • Image not available.Fat embolism syndrome classically presents within 72 h following long-bone or pelvic fracture, with the triad of dyspnea, confusion, and petechiae.
  • Image not available.Deep vein thrombosis and pulmonary embolism can be major causes of morbidity and mortality following orthopedic operations on the pelvis and lower extremities.
  • Image not available.Neuraxial anesthesia alone or when combined with general anesthesia may reduce thromboembolic complications by several mechanisms, including sympathectomy-induced increases in lower-extremity venous blood flow, systemic antiinflammatory effects of local anesthetics, decreased platelet reactivity, attenuated postoperative increase in factor VIII and von Willebrand factor, attenuated postoperative decrease in antithrombin III, and alterations in stress hormone release.
  • Image not available.Placement of an epidural needle or catheter (or removal) should generally not be undertaken within 6–8 h of a subcutaneous “minidose” of unfractionated heparin, or within 12–24 h of low-molecular-weight heparin. Although potentially less traumatic, spinal anesthesia may represent a similar risk.
  • Image not available.Flexion and extension lateral radiographs of the cervical spine should be obtained preoperatively in all patients with rheumatoid arthritis severe enough to require steroids or methotrexate. If atlantoaxial instability exceeds 5 mm, intubation should be performed with neck stabilization and an awake fiberoptic technique.
  • Image not available.Pulmonary artery monitoring in patients undergoing bilateral hip arthroplasties reliably signals embolization by a rise in pulmonary vascular resistance. If pulmonary artery pressures rise above normal (200 dyn × s × cm–5) during the first hip arthroplasty, the contralateral surgery should be postponed.
  • Image not available.Like bilateral cemented hip replacement, monitoring during bilateral knee replacement should include pulmonary artery and pulmonary artery occlusion pressure measurements.
  • Image not available.Effective postoperative analgesia is essential for early physical rehabilitation to maximize postoperative range of motion and prevent joint adhesions following knee replacement.
  • Image not available.The interscalene technique of brachial plexus blockade is ideally suited for shoulder procedures. Even when general anesthesia is employed, an interscalene block can supplement anesthesia and provide good postoperative analgesia.


Orthopedic surgery challenges the anesthesiologist with its diversity. The degree of surgical trespass varies from minor finger surgery to hemipelvectomy. Orthopedic patients range from neonates with congenital anomalies to healthy young athletes to immobile geriatric patients with end-stage multiorgan failure. Long bone fractures predispose to fat embolism syndrome. Patients may be at high risk for venous thromboembolism, particularly following pelvic, hip, and knee operations. Use of bone cement during arthroplasties can cause hemodynamic instability. Limb tourniquets limit blood loss but introduce additional risks. Neuraxial and other regional anesthetic techniques play an important role in decreasing the incidence of perioperative thromboembolic complications, providing postoperative analgesia, and facilitating early rehabilitation and hospital discharges. Advances in surgical techniques, such as minimally invasive ...

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