Orthopaedics Flashcards
Why turn off N2O before cementing in an arthroplasty?
Reduce risk VAE
What proportion of pts who have a total joint arthroplasty have a complication impacting a major organ system?
8%
Which nerve blocks should be avoided in hip replacement?
Those impairing motor function as they may delay mobilisation
What is more effective anaesthesia for THR? GA or RA? and analgesia; LIA or nerve block?
GA & RA equally effective (so a choice should be offered), no evidence to support the combo of RA& GA, either LA or RA to reduce postop pain & neither is more beneficial (BUT n blocks that impair motor function should be avoided as they delay mobilisation). Regional cost-effective & doesn’t delay surgery by >5mins
What is more effective anaesthesia for THR? GA or RA? and analgesia; LIA or nerve block?
GA & RA equally effective (so a choice should be offered), no evidence to support the combo of RA& GA, either LA or RA to reduce postop pain & neither is more beneficial (BUT n blocks that impair motor function should be avoided as they delay mobilisation). Regional cost-effective & doesn’t delay surgery by >5mins
Should we give TxA to pts with severe renal impairment?
No, it’s contraindicated
How should TxA be dosed during primary hip or knee replacement?
Give an IV dose. If NO renal impairment, also give 1-2g topical TxA (off-label) diluted in saline after final wash-out b4 closure but ensure combined total dose no >3g.
If renal impairment, give reduced dose IV TxA on it’s own, nil topical.
How should TxA be dosed during primary hip or knee replacement?
Give an IV dose. If NO renal impairment, also give 1-2g topical TxA (off-label) diluted in saline after final wash-out b4 closure but ensure combined total dose no >3g.
If renal impairment, give reduced dose IV TxA on it’s own, nil topical.
What are some considerations preop for THR? (NG 157)
Cognitive status & informed consent process
Consider ERAS principles:
-Pt-centred, multi-D, coordinated approach from contemplating OT until full recovery
-Pre-op education re:
expectations for surgery & recovery process
physiotherapy & exercises pre & postop to aid recovery
lifestyle advice: smoking & ETOH cessation, nutritional advice & weight loss, carb load
maximise functional independence & QoL pre-op
optimise comorbidities (eg. DM, ANS neuropathy, BP control)
CORRECT ANAEMIA & consider deferring surgery to allow anaemia correction
Pre-emptive analgesia
Pre-warm
If a pt is awaiting renal transplant, how do the outcomes compare if the joint replacement is done post- vs pre-transplant?
Better post-transplant
What are the intra-op considerations for THR? and postop?
Intraop: Multimodal analgesia (incl. regional), ABx, VTE prophylaxis, TxA (renal adjustment)
short-acting sedatives
blood conservation strategies
normothermic, normovolaemic
Postop: early mobilisation, early PO intake
What position are THR pts in for anterior approach & what are some of the benefits of anterior approach?
Supine. Muscles retracted vs cut so less tissue trauma, less pain & earlier mobilisation.
What are some considerations with pts who are obese presenting for THR?
They present earlier (up to 10 yrs earlier), tend to have longer OT, greater blood loss, higher risk of deep/superficial infections, higher revision rate & greater risk associated OSA
Should limb tourniquets be used for acute haemorrhage?
No- elevate & apply wound pressure with a well-padded bandage
