| Cambios perioperatorios en la circulación pulmonar durante artroplastia total bilateral de cadera bajo anestesia regional |
Perioperative pulmonary circulatory changes during bilateral total hip arthroplasty under regional anesthesia.
Memtsoudis SG, Salvati EA, Go G, Ma Y, Sharrock NE.
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA. MemtsoudisS@hss.edu
Reg Anesth Pain Med. 2010 Sep-Oct;35(5):417-21.
Abstract
BACKGROUND AND OBJECTIVES: The transient and rarely clinically relevant effect of bone and cement embolization during unilateral joint arthroplasty is a known phenomenon. However, available studies do not address events surrounding bilateral total hip arthroplasties, during which embolic load is presumably doubled. To elucidate events surrounding this increasingly used procedure and assess the effect on the pulmonary hemodynamics in the intraoperative and postoperative periods, we studied 24 subjects undergoing cemented bilateral total hip arthroplasty during the same anesthetic session. MATERIALS: Twenty-four patients without previous pulmonary history undergoing cemented bilateral total hip arthroplasty under controlled epidural hypotension were enrolled. Pulmonary artery catheters were inserted and hemodynamic variables were recorded at baseline, 5 mins after the implantation of each hip joint, 1 hr and 1 day after surgery. Mixed venous blood gases and complete blood counts were analyzed at every time point. RESULTS: An increase in pulmonary vascular resistance was observed after the second but not the first hip implantation when compared with values at incision. Pulmonary vascular resistance remained elevated 1 hr after surgery. Pulmonary artery pressures were significantly elevated on postoperative day 1 compared with those at baseline. The white blood cell count increased in response to the second hip implantation but not the first compared with incision. CONCLUSIONS: The embolization of material during bilateral total hip arthroplasty is associated with prolonged increases in pulmonary artery pressures and vascular resistance, particularly after completion of the second side. Performance of bilateral procedures should be cautiously considered in patients with diseases suggesting decreased right ventricular reserve.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935296/pdf/nihms225066.pdf
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| Actitudes actuales durante las técnicas de cementación en la cirugía Británica de cadera |
Current attitudes to cementing techniques in British hip surgery.
Hashemi-Nejad A, Birch NC, Goddard NJ.
Orthopaedic Department, Royal Free Hospital NHS Trust, London.
Ann R Coll Surg Engl. 1994 Nov;76(6):396-400.
Abstract
Aseptic loosening is the major problem in hip joint replacement. Improved cementing techniques have been shown to improve the long-term survival of implants significantly. To assess the use of modern cementing techniques in British surgeons, a detailed questionnaire was sent to all Fellows of The British Orthopaedic Association (BOA) regarding cement preparation, bone preparation, cementing technique and prostheses used in total hip arthroplasty. Excluding retired fellows, surgeons who use no cement, and those who had filled in forms inadequately, 668 responded, who between them performed 43,680 hip arthroplasties per year. In this survey, 21 different types of hip prostheses were implanted by the surgeons; 48% of hips implanted were Charnley type. Of the surgeons, 46% used Palacos with gentamicin as their cement for both the femur and acetabulum. For the femur, 44% of surgeons remove all cancellous bone, 40% use pulse lavage, 59% use a brush to clear debris, 94% dry the femur, 97% plug the femur, 76% use a cement gun and 70% pressurise the cement. For the acetabulum, 88% of surgeons retain the subchondral bone, 40% use pulse lavage, 100% dry the acetabulum, 22% use hypotensive anaesthesia and 58% pressurise the cement. Overall only 25% of surgeons (26% of hips implanted) use 'modern' cementing techniques. This has implications for the number of arthroplasties that may require early revision.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2502283/pdf/annrcse01592-0044.pdf
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| Marcadores de la generación de trombina durante artroplastia total de cadera durante ¨repavimentación¨ y no cementada: estudio piloto |
Markers of thrombin generation during resurfacing and noncemented total hip arthroplasty: a pilot study.
Su EP, Chatzoudis N, Sioros V, Go G, Sharrock NE.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
Clin Orthop Relat Res. 2011 Feb;469(2):535-40.
Abstract
BACKGROUND: Hip resurfacing arthroplasty (HRA) could be associated with an increased risk of deep vein thrombosis (DVT) compared to traditional noncemented THA because it involves greater dissection, increased kinking and distortion of the femoral vessels, takes longer to perform, and involves insertion of some cement into the femur. QUESTIONS/PURPOSES:
Does HRA lead to greater risk of thromboembolism compared with noncemented THA? METHODS: We prospectively studied 20 patients receiving HRA and 20 receiving THA. All patients were younger than 67 years old and were similar in height, weight, American Society of Anesthesiologists status, and gender mix. Patients undergoing HRA were younger (mean, 50 versus 59 years), their surgery was longer (mean, 87 versus 65 minutes), and they required more crystalloid during surgery (mean, 2160 versus 1662 mL). Radial artery blood samples were taken at six events during surgery and assayed for prothrombin fragment F1 + 2 and thrombin-antithrombin III complex (TAT) using enzyme-linked immunosorbent assays. RESULTS: We observed no differences in the intraoperative increases in F1 + 2 and TAT between the two groups and no differences in surgical events. CONCLUSION: Based on these data, HRA and THA should have similar risk of thromboembolism as THA based on the parameters we measured.
LEVEL OF EVIDENCE:
Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018220/pdf/11999
_2010_Article_1659.pdf
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