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Perioperative outcomes and type of anesthesia in hip surgical patients: An evidence based review

World Journal of Orthopedics 2014年第3期5卷 336-343页

作者： Mathias Opperer Thomas Danninger ottokar stundner Stavros G Memtsoudis Department of Anesthesiology Perioperative Medicine and Intensive Care MedicineParacelsus Medical UniversitySalzburg 5020Austria Department of Anesthesiology Hospital for Special SurgeryNew YorkNY 10021United States

Over the last decades the demand for hip surgery,be it elective or in a traumatic setting,has greatly increased and is projected to expand even *** with demographic changes the affected population is burdened by an increase in average comorbidity and serious *** has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a *** different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery *** studies on comparative effectiveness utilizing population based data have given us a novel insight on anesthetic practice and outcome,showing favorable results in the usage of regional vs general *** this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative *** there still remains a scarcity of data investigating perioperative outcomes and anesthesia,most studies concur on a positive outcome in overall mortality,thromboembolic events,blood loss and transfusion requirements when comparing regional to gener-al *** of the currently available evidence suggests that a comprehensive medical approach with emphasis on regional anesthesia can prove beneficial to patients and the health care system.

关键词： Perioperative outcome Regional anesthesia Neuraxial anesthesia Hip arthroplasty Hip fracture

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Pulmonary complications after spine surgery

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World Journal of Orthopedics 2012年第10期3卷 156-161页

作者： ottokar stundner Fadi Taher Abhijit Pawar Stavros G Memtsoudis Department of Anesthesiology Hospital for Special Surgery Weill Medical College of Cornell University Department of Spine Surgery Hospital for Special Surgery Weill Medical College of Cornell University

Spine surgery is one of the fastest growing branches of orthopedic surgery. Patients often present with a relatively high acuity and, depending on surgical approach, morbidity and mortality can be comparatively high. Among the most prevalent and most frequently fatalitybound perioperative complications are those affecting the pulmonary system; evidence of clinical or subclinical lung injury triggered by spine surgical procedures is emerging. Increasing burden of comorbidity among the patient population further increases the likelihood of adverse outcome. This review is intended to give an overview over some of the most important causes of pulmonary complications after spine surgery, their pathophysiology and possible ways to reduce harm associated with those conditions. We discuss factors surrounding surgical trauma, timing of surgery, bone marrow and debris embolization, transfusion associated lung injury, and ventilator associated lung injury.

关键词： Spine surgery Complications Pulmonary Pulmonary embolism Transfusion-associated lung injury Ventilator-associated lung injury

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Microvascular response to transfusion in elective spine surgery

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World Journal of Orthopedics 2017年第1期8卷 49-56页

作者： J Matthias Walz ottokar stundner Federico P Girardi Bruce A Barton Aimee R Koll-Desrosiers Stephen O Heard Stavros G Memtsoudis Department of Anesthesi-ology and Perioperative Medicine UMass Memorial Healthcare Department of Anesthesiology Hospital for Special SurgeryWeill Cornell Medical Center Department of Anesthesiology PerioperativeMedicine and Intensive Care MedicineParacelsus Medical University Department of Orthopedic Surgery Hospital for Special SurgeryWeill Cornell Medical Center Department of Quantitative Health Sciences University of Massachusetts Medical School

AIM To investigate the microvascular(skeletal muscle tissue oxygenation; SmO_2) response to transfusion in patients undergoing elective complex spine *** After IRB approval and written informed consent, 20 patients aged 18 to 85 years of age undergoing > 3level anterior and posterior spine fusion surgery were enrolled in the study. Patients were followed throughout the operative procedure, and for 12 h postoperatively. In addition to standard American Society of Anesthesiologists monitors, invasive measurements including central venous pressure, continual analysis of stroke volume(SV), cardiac output(CO), cardiac index(CI), and stroke volume variability(SVV) was performed. To measure skeletal muscle oxygen saturation(SmO_2) during the study period, a non-invasive adhesive skin sensor based on Near Infrared Spectroscopy was placed over the deltoid muscle for continuous recording of optical spectra. All administration of fluids and blood products followed standard procedures at the Hospital for Special Surgery, without deviation from usual standards of care at the discretion of the Attending Anesthesiologist based on individual patient comorbidities, hemodynamic status, and laboratory data. Time stamps were collected for administration of colloids and blood products, to allow for analysis of SmO_2 immediately before, during, and after administration of these fluids, and to allow for analysis of hemodynamic data around the same time points. Hemodynamic and oxygenation variables were collected continuously throughout the surgery, including heart rate, blood pressure, mean arterial pressure, SV, CO, CI, SVV, and SmO_2. Bivariate analyses were conducted to examine the potential associations between the outcome of interest, SmO_2, and each hemodynamic parameter measured using Pearson's correlation coeffi-cient, both for the overall cohort and within-patients individually. The association between receipt of packed red blood cells and SmO_2 was performed by runni

关键词： Transfusion Complex spine surgery Near infrared spectroscopy Microvascular blood flow Hemodynamic monitoring

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