ABSTRACT
The case of a 62-year-old Caucasian woman who underwent urgent hip hemiarthroplasty for repair of a pathological fracture is reported. The patient's medical history was significant for renal cell carcinoma, cerebellar metastases, and sunitinib-induced hypothyroidism. Her intraoperative course was complicated by profound hypothermia, bradycardia, augmentation of neuromuscular blockade, delayed emergence, failure of postoperative extubation, and need for mechanical ventilation. The intensive care course was significant for hypothermia requiring forced-air warming, treatment with intravenous thyroxine (T4), and hemodynamic supportive care.
Subject(s)
Antineoplastic Agents/adverse effects , Coma/chemically induced , Indoles/adverse effects , Myxedema/chemically induced , Postoperative Complications/chemically induced , Pyrroles/adverse effects , Arthroplasty, Replacement, Hip , Female , Femoral Fractures/surgery , Humans , Middle Aged , SunitinibABSTRACT
BACKGROUND: Paraplegia is a devastating complication for patients undergoing repair of thoracoabdominal aortic aneurysms. A monitor to detect spinal cord ischemia is necessary if anesthesiologists are to intervene to protect the spinal cord during aortic aneurysm clamping. METHODS: The medical records of 60 patients who underwent thoracoabdominal aortic aneurysm repair with regional lumbar epidural cooling with evoked potential monitoring were reviewed. The authors analyzed latency and amplitude of motor evoked potentials, somatosensory evoked potentials, and H reflexes before cooling and clamping, after cooling and before clamping, during clamping, and after release of aortic cross clamp. RESULTS: Twenty minutes after the aortic cross clamp was placed, motor evoked potentials had 88% sensitivity and 65% specificity in predicting spinal cord ischemia. The negative predictive value of motor evoked potentials at 20 min after aortic cross clamping was 96%. CONCLUSIONS: Rapid loss of motor evoked potentials or H reflexes after application of the aortic cross clamp identifies a subgroup of patients who are at high risk of developing spinal cord ischemia and in whom aggressive anesthetic and surgical interventions may be justified.
Subject(s)
Aortic Aneurysm, Thoracic/surgery , Epidural Space/physiology , Evoked Potentials, Motor/physiology , Evoked Potentials, Somatosensory/physiology , Hypothermia, Induced/methods , Spinal Cord Ischemia/prevention & control , Aged , Aortic Aneurysm, Thoracic/physiopathology , Female , Humans , Hypothermia, Induced/instrumentation , Lumbosacral Region/physiology , Male , Middle Aged , Monitoring, Intraoperative/instrumentation , Monitoring, Intraoperative/methods , Predictive Value of Tests , Retrospective Studies , Spinal Cord Ischemia/physiopathologyABSTRACT
Two techniques of postoperative analgesia for primary total knee arthroplasty were compared retrospectively. Twenty-four patients received a femoral nerve catheter with continuous infusion of ropivacaine (FNC group), whereas 26 patients received intravenous (IV) opioids (IV opioid group). Pain and rehabilitation scores and hospital length of stay (LOS) were compared. On the first postoperative day, both groups reported similar pain scores. After 4 sessions of twice-daily rehabilitation, the FNC group used less IV patient-controlled opioids (29.1% vs 84.5%, P = .0001) and demonstrated better performance with knee flexion and mobility. Hospital LOS was significantly less in the FNC group (3.6 vs 4.2 days, P = .034). Femoral nerve catheters with continuous infusion of ropivacaine provide satisfactory analgesia, improve rehabilitation, and shorten hospital LOS.
