Anesthesia for orthopaedic replacement surgeries. Prof.Dr.K.BALAKRISHNAN, Chennai. Introduction. Some of the common joint replacement surgeries are 1. Hip replacement 2. Knee replacement 3. Shoulder replacement 4. Elbow replacement.
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1. Hip replacement
2. Knee replacement
3. Shoulder replacement
4. Elbow replacement
Total knee replacement (TKR) and hip fracture coming for replacement are the two most common surgical procedures after the sixth decade of life.
Most of the patients have degenerative joint disease, commonly osteoarthritis (OA).
Other conditions requiring knee or hip replacement are injury to the neck of femur or knee joint, knee deformity, rheumatoid arthritis and gout.
And anaesthesiologists are
mankind’s guardian angels.
The straw that breaks the camel’s back may be a very small one when the camel is nearing the end of it’s journey !
i) surgical factors
ii) Patients factors
iii) Estimates of risk associated with anaesthesia techniques
- Epidural anesthesia
- Combined spinal epidural anaesthesia
- Femoral and Sciatic nerve blocks (especially in patients with fixed cardiac output in whom a neuraxial block is not preferred due to possible haemodynamic changes specifically profound hypotension).
Short acting and less lipid soluble drugs
5 lead ECG-ST analysis
Progressive reaming of femur and resection of the condyles is associated with steady blood loss
The placement of the prosthesis involve the use of methylmethacrylate
( bone cement )
These fluctuations are related to the vasodilatory and mast-cell degranulating properties of the monomeric form of methylmethacrylate
Bonecementimplantation syndrome (BCIS) is poorly understood. It is an important cause of intraoperative mortality and morbidity in patients undergoing cemented hip arthroplasty and may also be seen in the postoperative period in a milder form causing hypoxia and confusion.
BCIS may be reversible with prompt basic life support and treatment to maintain both coronary perfusion pressure and right heart function.
Administer fluid volumes to augment right ventricular preload. Direct acting vasopressors, such as phenylephrine and norepinephrine can be titrated to restore adequate aortic perfusion
To improve ventricular contractility and function administer inotropes such as dobutamine.
The high incidence of fat embolism with femoral neck fracture repair and cemented endoprosthesis may contribute to pulmonary dysfunction
may precipitate heart failure
may cause hypotension after release of tourniquet
Release of acid products
Affected limb getting filled with blood
- local anaesthetic infusions through perineural catheters supplemented with analgesics including a combination of paracetamol, tramadol, NSAID(when there is no contraindication) and opioids.
No.1: Start with low dose
Avoid long acting drugs
No.2: Use standing dose regimens
No.3: Repeated reassessment of pain relief
No.4: Repeated reassessment of side effects
No.5: Educate/inspire the care giver
Peri- operative Antibiotics