ABSTRACT
BACKGROUND: Anesthesia for patients who undergo surgery for femoral neck fractures can be associated with severe cardiopulmonary complications. METHODS: We retrospectively studied 361 consecutive patients who underwent surgery for femoral neck fractures. Dividing patients into three groups according to type of surgery-hip hemiarthroplasty (n=134), compression hip screw (n=123) or gamma nail (n=104)--we calculated the incidences of cardiorespiratory deterioration during anesthesia and examined factors associated with it. RESULTS: Among hemiarthroplasty patients, six (4.5%) encountered cardiorespiratory deterioration; four (3.0%) experienced profound hypotension, bradycardia or cardiac arrest immediately after implantation of the bone cement or insertion of the prosthesis into the femoral bone; and two (1.5%) developed hypoxia and angina pectoris during the late phase of surgery. Patients who underwent compression hip screw or gamma nail had no cardiorespiratory deterioration. No difference was found in patient characteristics or type of anesthesia used among the three surgery groups. Time of surgery and amount of blood loss both were significantly greater in patients undergoing hemiarthroplasty. CONCLUSIONS: The surgical techniques selected for hip hemiarthroplasty, which is associate with an increase in intramedullary pressure, may be a significant risk factor for cardiorespiratory deterioration from anesthesia in patients undergoing surgery for femoral neck fracture.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Bone Cements/adverse effects , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/etiology , Femoral Neck Fractures/surgery , Respiration Disorders/etiology , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Humans , Incidence , Male , Respiration Disorders/epidemiology , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Intrathecal morphine for postoperative analgesia after caesarean section has been used in Europe and North America, but its use is not common in Japan. METHODS: We randomized 40 parturients to two groups, given either intrathecal saline (control group) or intrathecal morphine 0.05 mg (morphine group) for caesarean section. To both groups, we gave a diclofenac suppository 50 mg every 8 hours after surgery. RESULTS: The area under curve for the visual analogue scale for pain during 24 hours after operation was significantly lower (P < 0.01) in the morphine group than the control group. In addition, the parturients who required pentazocine as a rescue analgesia was significantly fewer in the morphine group (5 parturients) than the control group (11 parturients). There was no significant difference between the two groups in the Apgar score of infants, pH in umbilical cord arterial and venous blood and the incidence of postoperative nausea and vomiting. The incidence of pruritus was significantly higher in the morphine group (11 parturients) than the control group (no parturient). CONCLUSIONS: Intrathecal morphine 0.05 mg and diclofenac suppository 50 mg given every 8 hours produced effective postoperative analgesia with minimum side effects after caesarean section.
