Clinical conundrums and challenges during geriatric orthopedic emergency surgeries

Influence of epidural anesthesia and general anesthesia on thromboembolism in patients undergoing total knee arthroplasty

OBJECTIVE

This study aimed to explore the application value of epidural and general anesthesia in total knee arthroplasty (TKA).

METHODS

We first retrospectively analyzed 156 patients who underwent total knee arthroplasty in our hospital from January 2019 to January 2020 as subjects. The control group (CG) included 86 subject who were treated with general anesthesia. The remaining 70 subjects with epidural anesthesia were divided to a research group (RG). The recovery and adverse reactions after surgery were compared. The coagulation function before and after surgery was analyzed. The incidence of deep vein thrombosis (DVT) after surgery was observed. The expression of inflammatory factors and the improvement of cognitive function were assessed before surgery, followed by 6 and 12 h after surgery. The pain degree of patients was compared at 6 and 12 h after surgery.

RESULTS

Compared with the CG, the recovery condition after surgery in the RG were dramatically lower, the concentrations of PLT, PT, and APTT in the RG were higher, while FBG was markedly lower. The incidence of postoperative venous thrombosis in the RG was lower. The TNF-α, IL-6 levels, and VAS scores in the RG were remarkably lower at 6 and 12 h after surgery. MMSE score was significantly higher than CG score. The total incidence of adverse reactions in the RG was markedly lower.

CONCLUSION

Epidural anesthesia can improve blood coagulation and cognitive function in patients undergoing TKA and reduce the incidence of DVT and the degree of postoperative pain.

Impact of Preoperative Echocardiography on Perioperative Management in Geriatric Hip Trauma: A Retrospective Observational Study

BACKGROUND AND AIM

Hip fractures are associated with a significant risk of morbidity and mortality in the elderly population. Current guidelines propose that these patients should be operated as early as possible. Preoperative cardiac investigations, especially echocardiography, have been considered to delay surgery with few changes in the patient management. The present study has been conducted to evaluate whether preoperative echocardiography improve or worsen the prognosis in such hip trauma surgery.

MATERIALS AND METHODS

In this retrospective study, we reviewed the records of elderly patients with hip trauma operated in the tertiary care trauma center of our institute over a period of 1 year. Out of 120 patients, preoperative echocardiography was done in 30 patients. We compared the patients for whom echocardiography was done with the patients who did not undergo echocardiography. Descriptive statistical methods were used to analyze the results and observations.

RESULTS

We observed that preoperative transthoracic echocardiography led to an escalation in cardiac medication in 53% patients when compared with 23.3% in patients who did not undergo echocardiography. No preoperative cardiac intervention was done in any patient. However, there was a delay of 2.5 days in surgery in the echocardiography group as compared to the patients of nonechocardiography group. Rate of regional anesthesia was comparable in both the groups (54% vs. 56.6%).

CONCLUSIONS

In the present study, it was observed that echocardiography significantly delays surgery without a significant change in preoperative cardiac medication or anesthesia technique. This may have a potential possible adverse effect on the outcome in geriatric hip trauma which was not observed to a significant limit in the present study as the study was not a longitudinal study. For "fast tracking" of geriatric hip trauma, institutional guidelines should be developed depending on the resources available.