TY  - CHAP
M1  - Book, Section
TI  - Anesthesia for Orthopedic Surgery
A1  - Mariano, Edward R.
A1  - Leng, Jody C.
A2  - Butterworth IV, John F.
A2  - Mackey, David C.
A2  - Wasnick, John D.
Y1  - 2022
N1  - 
T2  - Morgan & Mikhail’s Clinical Anesthesiology, 7e
AB  - KEY  CONCEPTS  Clinical  manifestations  of  bone  cement  implantation  syndrome  include  hypoxia  (increased  pulmonary  shunt),  hypotension,  arrhythmias  (including  heart  block  and  sinus  arrest),  pulmonary  hypertension  (increased  pulmonary  vascular  resistance),  and  decreased  cardiac  output.  The  use  of  a  pneumatic  tourniquet  on  an  extremity  creates  a  bloodless  field  that  may  facilitate  surgery.  However,  tourniquets  can  produce  potential  problems  of  their  own,  including  hemodynamic  changes,  pain,  metabolic  alterations,  arterial  thromboembolism,  and  pulmonary  embolism.  Fat  embolism  syndrome  classically  presents  within  72  h  following  long-bone  or  pelvic  fracture,  with  the  triad  of  dyspnea,  confusion,  and  petechiae.  Deep  vein  thrombosis  and  pulmonary  embolism  can  cause  morbidity  and  mortality  during  and  following  orthopedic  operations,  particularly  those  procedures  involving  the  pelvis  and  lower  extremities.  Neuraxial  anesthesia  alone  or  combined  with  general  anesthesia  may  reduce  thromboembolic  complications  by  several  mechanisms,  including  sympathectomy-induced  increases  in  lower  extremity  venous  blood  flow,  systemic  anti-inflammatory  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.  Preoperatively,  neuraxial  techniques  may  be  performed  after  waiting  at  least  12  h  after  a  prophylactic  low-molecular-weight  heparin  (LMWH)  dose.  Postoperatively,  neuraxial  catheters  may  be  maintained  in  patients  who  receive  once-daily  prophylactic  dosing,  and  catheters  should  be  removed  at  least  12  h  after  the  previous  dose.  Following  catheter  removal,  the  next  dose  may  be  given  after  a  4  h  delay.  For  postoperative  patients  who  receive  twice-daily  prophylactic  dosing,  neuraxial  catheters  should  not  be  left  in  situ  and  should  be  removed  4  or  more  hours  before  the  first  dose  of  LMWH.  For  therapeutic  dosing  of  LMWH,  a  longer  wait  time  of  24  h  after  the  previous  dose  is  recommended  prior  to  any  neuraxial  technique.  Flexion  and  extension  lateral  radiographs  of  the  cervical  spine  should  be  obtained  preoperatively  in  patients  with  rheumatoid  arthritis  severe  enough  to  require  steroids,  immune  therapy,  or  methotrexate.  If  atlantoaxial  instability  is  present,  intubation  should  be  performed  with  in-line  stabilization  utilizing  video  or  fiberoptic  laryngoscopy.  Effective  communication  between  the  anesthesia  practitioner  and  surgeon  is  essential  during  bilateral  hip  arthroplasty.  If  major  hemodynamic  instability  occurs  during  the  first  hip  replacement  procedure,  the  second  arthroplasty  should  be  postponed.  Adjuvants  such  as  opioids,  clonidine,  ketorolac,  and  neostigmine,  when  added  to  local  anesthetic  solutions  for  intraarticular  injection,  have  been  used  in  various  combinations  to  extend  analgesic  duration  following  knee  arthroscopy.  Effective  postoperative  multimodal  analgesia  facilitates  early  physical  rehabilitation  to  maximize  postoperative  range  of  motion  and  prevent  joint  adhesions  following  knee  replacement.  Interscalene  brachial  plexus  block  with  or  without  a  perineural  catheter  is  ideally  suited  for  shoulder  procedures.  Even  when  general  anesthesia  is  employed,  a  peripheral  nerve  or  brachial  plexus  block  can  supplement  intraoperative  anesthesia  and  provide  effective  postoperative  analgesia.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/18
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1190608485
ER  -