Current Approaches in Hip and Knee Arthroplasty Anaesthesia.

Risk assesment, preoperative drug regulation, the anesthesia and analgesia techniques are very important and the effectivity on success of surgery is great. So, these topics in arthroplasty were reviewed under current knowledge.

Hip fracture mortality: is it affected by anesthesia techniques?

We hypothesized that combined peripheral nerve block (CPNB) technique might reduce mortality in hip fracture patients with the advantage of preserved cardiovascular stability. We retrospectively analyzed 257 hip fracture patients for mortality rates and affecting factors according to general anesthesia (GA), neuraxial block (NB), and CPNB techniques. Patients' gender, age at admission, trauma date, ASA status, delay in surgery, followup period, and Barthel Activities of Daily Living Index were determined. There were no differences between three anesthesia groups regarding to sex, followup, delay in surgery, and Barthel score. NB patients was significantly younger and CPNB patients' ASA status were significantly worse than other groups. Mortality was lower for regional group (NB + CPNB) than GA group. Mortality was increased with age, delay in surgery, and ASA and decreased with CPNB choice; however, it was not correlated with NB choice. Since the patients' age and ASA status cannot be changed, they must be operated immediately. We recommend CPNB technique in high-risk patients to operate them earlier.

Predictors of mortality in elderly patients with an intertrochanteric or a femoral neck fracture.

BACKGROUND: We retrospectively analyzed 112 intertrochanteric femur fracture patients and 136 femoral neck fracture patients to determine mortality rates and factors affecting mortality. Internal fixation is the standard treatment method for intertrochanteric femur fracture patients in our institute, and arthroplasty, as a treatment choice, shows an increase in mortality rates. We wanted to convey if there was any decrease in mortality rate of intertrochanteric femur fracture patients when compared with femoral neck fracture patients who were almost always treated with arthroplasty. METHODS: Patients' age at admission, trauma date, delay until surgery, comorbidities, operation durations, anesthesia, and treatment types were evaluated by patients' folders. All preoperative and postoperative radiographs checked over for treatment type. Patients' recent health and activity status were determined by telephone interview. RESULTS: There were no significant differences in mortality rates between patients of two fracture types. Treatment type, anesthesia type, and sex were significant predictors in univariate analyses. In multivariate analyses, only age and delay in surgery identified as predictors of mortality, age was the most significant. Although intertrochanteric femur fracture patients were significantly older than femoral neck fracture patients, the estimated mean survival time was higher for intertrochanteric femur fracture patients (57.9 months) than for femoral neck fracture patients (48.8 months). CONCLUSION: We think that, in addition to the shorter delay in surgery, internal fixation choice led to decrease the mortality rate of intertrochanteric femur fracture patients. In conclusion, to decrease the mortality rate after hip fracture, since age and sex cannot be changed, needless delays in surgery should be avoided. Also, we recommend internal fixation and regional anesthesia to decrease the mortality rate.

Effect of intra-abdominal pressure level on gastric intramucosal pH during pneumoperitoneum.

The present study was designed to examine the effect of intra-abdominal pressure level on gastric intramucosal pH using gastric tonometry during pneumoperitoneum. One hundred patients were prospectively randomized into 5 equal groups (N = 20 each). Intra-abdominal pressure levels were 8, 10, 12, 14, and 16 mm Hg in groups I, II, III, IV, and V, respectively. Intramucosal pH measurement was done 2 times: 30 minutes following insufflation and 1 hour after the ending of the surgery. In the first and second measurements, intramucosal pH values were found as 7.39 +/- 0.02 and 7.36 +/- 0.03 in group I; 7.41 +/- 0.03 and 7.38 +/- 0.03 in group II; 7.37 +/- 0.03 and 7.37 +/- 0.03 in group III; 7.36 +/- 0.03 and 7.37 +/- 0.03 in group IV; and 7.39 +/- 0.03, 7.36 +/- 0.03 in group V, respectively. Statistical significance was not found in the comparison of these values within the groups and between the groups (P > 0.005, for each). In conclusion, intra-abdominal pressure between 8 and 16 mm Hg did not cause significant difference in gastric intramucosal pH.

Anesthetic management of a patient with Freeman-Sheldon syndrome.

The Freeman-Sheldon syndrome (FSS) is rare congenital myopathy and dysplasia. The musculoskeletal and soft-tissue manifestations of FSS often require orthopedic and plastic reconstructive surgery. We report a case of 19-month-old girl with FSS.

Effects of sevoflurane versus TIVA on gastric intramucosal pH and hemodynamic status in colon cancer surgery.

BACKGROUND: Gastric tonometry is a minimally invasive device by which the adequacy of splanchnic blood flow is assessed indirectly. Patients undergoing major abdominal surgery are under the risk of developing splanchnic ischemia. The aim of this study was to compare gastric intramucosal pH and hemodynamic effects between sevoflurane and TIVA achieved by propofol. METHODS: Forty patients of ASA I-II were studied. Twenty patients received sevoflurane (Group S) and 20 patients received TIVA by propofol (Group P). Continuous measurements were made at four intervals: (a) 30 minutes before the starting of the surgery, (b) at the first hour of the surgery, (c) at the second hour of the surgery, (d) at the first hour after ending of the surgery. The mean arterial pressure, heart rate, SpO2, EtCO2, body temperature, central venous pressure, urine output, intramucosal and arterial pH were monitored. RESULTS: There were no significant differences between two groups regarding the studied parameters. CONCLUSIONS: Sevoflurane and propofol did not cause any significant difference in hemodynamic effects and splanchnic circulation measured by gastric tonometry in ASA I-II patients operated on for colon cancer.