Reducing Risk in Bilateral Total Knee Arthroplasty

As the utilization of total knee arthroplasty increases and the population ages, the number of patients who require surgical treatment of both knees is rising. These procedures may be conducted simultaneously or sequentially; the simultaneous bilateral approach is increasingly considered the preferred option because it permits a symmetric recovery while avoiding risks associated with an additional operation, anesthetic, hospitalization, and recovery period while reducing the costs associated with sequential procedures. Despite these advantages, concerns have been raised regarding increased risks for deep vein thrombosis, pulmonary embolism, cardiac complications, and mortality. Results reported in the literature with regards to the relative safety of these procedures have been conflicting; however, it is agreed upon that careful patient selection is essential for reducing risk associated with simultaneous bilateral total knee arthroplasty. A set of guidelines have been established which may be used to help guide the management of patients with bilateral degenerative joint disease seeking knee replacement surgery.
Source: Techniques in Orthopaedics - Category: Orthopaedics Tags: Symposium Source Type: research

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ConclusionsThe overall VTE rate after CABG has been low. However, the condition has been associated with worse 30-day postoperative outcomes and complications. The independent predictors of VTE development included a history of bleeding disorders, congestive heart failure in the 30 days before surgery, and operative time of ≥310 minutes. Understanding these risk factors should aid physicians in the decisions regarding prophylaxis and treatment.
Source: Journal of Vascular Surgery: Venous and Lymphatic Disorders - Category: Surgery Source Type: research
ology; Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation; and Council on Cardiovascular Surgery and Anesthesia Abstract Pulmonary embolism (PE) represents the third leading cause of cardiovascular mortality. The technological landscape for management of acute intermediate- and high-risk PE is rapidly evolving. Two interventional devices using pharmacomechanical means to recanalize the pulmonary arteries have recently been cleared by the US Food and Drug Administration for marketing, and several others are in various stages of development. The purpose of this document is to clarify the curr...
Source: Circulation - Category: Cardiology Authors: Tags: Circulation Source Type: research
r M Abstract OBJECTIVE: Fast track concepts are used to reduce the risk of perioperative and postoperative complications after total knee arthroplasty. INDICATIONS: The described concepts are used for patients with indications for the implantation of a total knee prosthesis. CONTRAINDICATIONS: Contraindications for fast track concepts are aged patients, dementia, American Society of Anesthesiologists (ASA) grade IV and implantation of large revision or tumor prostheses. Contraindications for tranexamic acid are bleeding in the urinary tract, caution in cases of known epilepsy, individual risk assessment ...
Source: Operative Orthopadie und Traumatologie - Category: Orthopaedics Authors: Tags: Oper Orthop Traumatol Source Type: research
This study aimed to evaluate a pregnancy-adapted version of the YEARS algorithm for the management of suspected pulmonary embolism during pregnancy.
Source: Obstetric Anesthesia Digest - Category: Anesthesiology Tags: Mechanisms, Equipment, Hazards Source Type: research
THE STUDY BY Fukazawa et al.1 was a retrospective analysis of 56 renal cell cancer patients who underwent nephrectomy with inferior vena cava (IVC) thrombectomy from 2014 –2017 at the University of Washington Medical Center. The authors sought to quantify growth of IVC tumor burden during the interval between imaging and surgical resection in order to develop recommendations for optimal timing of imaging and determine whether tumor thrombus level as defined by the Mayo Clinic criteria at the time of surgery correlated with the risk of perioperative pulmonary embolism (PE).
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Editorial Source Type: research
We report on a 53 ‐year‐old female patient who suffered a perioperative death secondary to a pulmonary embolism (PE) during an implantation of Endo‐Exo‐Prosthesis. This is a retrospective review of medical case for a patient who had a previous above‐the‐knee amputation secondary to a failed previous arthr oplasty surgery. Our planned surgery was a stage 1 implantation of an Endo‐Exo‐Prosthesis, and it was performed under general anaesthesia. After 25 min from starting the surgical procedure, the patient sustained a cardiac arrest, and despite an active cardiopulmonary resuscitation for 50 min, the...
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Case Report Source Type: research
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; &AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regio...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Authors: Zhong H, Wang Y, Wang Y, Wang B Abstract Effect and clinical value in general anesthesia and combined spinal-epidural anesthesia in elderly patients undergoing hip arthroplasty were compared. One hundred and six patients with hip arthroplasty in the Affiliated Nanhua Hospital, University of South China from May 2013 to July 2015 were selected as the research subjects, including 50 patients in the study group who received combined spinal-epidural anesthesia by ondansetron hydrochloride tablets combined with spinal-epidural puncture kit, and 56 patients in the control group who received general anesthesia by...
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
ConclusionAdministration of ESA and iron therapy reduced the risk for RBC transfusion compared with iron therapy alone in patients undergoing cardiac and non-cardiac surgery. Nevertheless, publication bias and heterogeneity reduces the confidence of the finding. Although the analysis was probably under-powered for some outcomes, no difference in the incidence of serious adverse events was observed with ESA and iron compared with iron alone. Further large prospective trials are required to confirm these findings.
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research
To analyze preoperative tumor thrombus progression and occurrence of perioperative pulmonary embolism (PE) in patients with inferior vena cava tumor thrombus resection.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Original Article Source Type: research
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