ABSTRACT
Hip arthroplasty is a common surgical intervention in our hospital practice, involving high perioperative risk related to patients age and multiple concomitant diseases. Hemodynamic complications described vary from slight hypotension during surgery to heart failure and sudden death, particularly if the operation involves a cemented femoral component. Because of the type of patients undergoing such operations (elderly patients, with osteoporosis and scarce cardiopulmonary reserve), the unclear origin of complications and the lack of consensus on what constitutes adequate monitoring during surgery, hip arthroplasty is problematic for the specialists involved. We report on five deaths during cemented hip arthroplasty; after reviewing the case history and autopsy report of one, we believe the events leading to death were triggered by massive pulmonary embolism.
Subject(s)
Bone Cements/adverse effects , Heart Arrest/etiology , Hip Prosthesis/adverse effects , Pulmonary Embolism/complications , Pulmonary Embolism/etiology , Aged , Aged, 80 and over , Female , Humans , MaleABSTRACT
La artroplastia de cadera es una intervención quirúrgica muy frecuente en nuestro medio hospitalario y que conlleva un riesgo perioperatorio elevado por la edad avanzada de los pacientes y la múltiple patología concomitante. Las complicaciones hemodinámicas descritas varían desde la leve hipotensión intraoperatoria hasta la parada cardíaca y la muerte súbita, sobre todo si se trata de artroplastia de cadera con componente femoral cementado.El tipo de pacientes sometidos a esta intervención (ancianos, con osteoporosis y escasa reserva cardiorrespiratoria), la etiología no aclarada de las complicaciones y la falta de consenso acerca de la monitorización intraoperatoria adecuada convierten la artroplastia de cadera en un problema para los especialistas implicados en la misma.Presentamos 5 casos de muerte intraoperatoria en pacientes sometidos a artroplastia de cadera cementada, en los que, a juzgar por la clínica y el estudio necrópsico en uno de ellos, creemos que el cuadro fue desencadenado por un embolismo pulmonar masivo (AU)
Subject(s)
Aged , Aged, 80 and over , Male , Female , Humans , Pulmonary Embolism , Bone Cements , Hip Prosthesis , Heart ArrestABSTRACT
We report two cases of acute pulmonary edema attributable to episodes of postextubation laryngospasm appearing when two young patients awoke after appendectomies under general anesthesia. Both patients improved in less than 48 hours with diuretics, oxygen therapy and liquid restriction, making tracheal intubation unnecessary. The pathophysiology and clinical and radiological signs of pulmonary edema are reviewed.
Subject(s)
Laryngismus/complications , Pulmonary Edema/etiology , Adult , Humans , MaleSubject(s)
Alcoholism/complications , Compartment Syndromes/chemically induced , Heroin Dependence/complications , Immobilization/adverse effects , Leg/blood supply , Rhabdomyolysis/chemically induced , Substance Abuse, Intravenous/complications , Unconsciousness/chemically induced , Acute Kidney Injury/etiology , Acute Kidney Injury/prevention & control , Adolescent , Compartment Syndromes/diagnosis , Edema/etiology , Hematuria/etiology , Humans , Ischemia/etiology , Male , Necrosis , Oliguria/etiology , Paresthesia/etiology , Rhabdomyolysis/diagnosis , Unconsciousness/complicationsSubject(s)
Anaphylaxis/therapy , Echinococcosis, Hepatic/complications , Anaphylaxis/etiology , Anesthetics, Inhalation/adverse effects , Contraindications , Diagnosis, Differential , Echinococcosis, Hepatic/diagnosis , Etomidate/adverse effects , Female , Humans , Mitral Valve Stenosis/complications , Nitrous Oxide/adverse effects , Oxygen/administration & dosage , Rupture, Spontaneous , Splenic Rupture/diagnosisSubject(s)
Anesthesia , Klippel-Trenaunay-Weber Syndrome/complications , Leg Ulcer/surgery , Adolescent , Humans , Leg Ulcer/complications , MaleABSTRACT
OBJECTIVES: To determine whether locally injected ketorolac provides analgesia additional to that of mepivacaine, and also to prevent, diminish or delay the peripheral hypersensitivity response of postoperative pain. PATIENTS AND METHODS: Prospective, randomized, double-blind study of 72 patients scheduled for surgery to correct unilateral hallux valgus. Group 1 (n = 24) received median infiltration at the first metatarsus of 5 ml of 2% mepivacaine and 1 ml (30 mg) of ketorolac. Group 2 (n = 21) received local infiltration of 5 ml of 2% mepivacaine and 1 ml of saline solution. Group 3, the control group (n = 27) received the same solution as did group 2, plus 30 mg of ketorolac intravenously. The postoperative analgesia prescribed was 10 mg of ketorolac orally every 8 hours. Pain was measured on a visual analog scale (VAS) 0, 1, 4, 8 and 24 hours after surgery. Time elapsed until the appearance of pain, number of ketorolac pills consumed and overall patient satisfaction were recorded. RESULTS: There were no differences in anthropometric characteristics. Time until pain appeared was significantly longer in group 1 than in groups 2 and 3 (14.66 +/- 7.19, 5.90 +/- 2.27 and 8.70 +/- 5.02 hours, respectively). The VAS scores were significantly lower in group 1 after the fourth postoperative hour. Analgesic consumption was significantly lower in group 1. CONCLUSIONS: Infiltration of 30 mg of ketorolac along with mepivacaine delays the appearance of postoperative pain and diminishes it in the first 24 hours after surgery to correct hallux valgus, in comparison with infiltration of mepivacaine alone plus intravenous ketorolac.
