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The Role of the Post-anesthesia Care Unit in the Perioperative Care of the Orthopedic Patient

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Perioperative Care of the Orthopedic Patient
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Abstract

The postoperative care unit at the Hospital for Special Surgery plays an important part in the overall perioperative care of the orthopedic patient. In order to optimize patient outcomes the postoperative care of orthopedic patients should focus on observation of organ function, monitoring of the resolution of anesthesia, resuscitation of blood loss and its consequences, and adequate pain management. In order to assure best possible outcomes, physicians caring for orthopedic patients need to be familiar with common perioperative complications in order to address them expediently. The model of postoperative care at the Hospital for Special Surgery, which allows for the adjustment of recovery room resources to care for problems encountered at various stages of the hospitalization, has proven efficient and successful. In this chapter we describe and discuss the various functions of the postoperative care unit and how we address the challenges encountered.

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References

  1. Kluger MT, Bullock MF. Recovery room incidents: a review of 419 reports from the anaesthetic incident monitoring study (AIMS). Anaesthesia. 2002;57:1060–6.

    Article  CAS  PubMed  Google Scholar 

  2. Sharrock NE, Mineo R, Urquhart B. Haemodynamic effects and outcome analysis of hypotensive extradural anaesthesia in controlled hypertensive patients undergoing total hip arthroplasty. Br J Anaesth. 1991;67:17–25.

    Article  CAS  PubMed  Google Scholar 

  3. Kitchen AD, Barbara JAJ. Current information on the infectious risks of allogeneic blood transfusion. TATM. 2008;10:102–11.

    Google Scholar 

  4. Kumar A. Perioperative management of anemia: limits of blood transfusion and alternatives to it. Cleve Clin J Med. 2009;76 Suppl 4:S112–8.

    Article  PubMed  Google Scholar 

  5. Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, Nemo G, Dragert K, Beaupre L, Hildebrand K, Macaulay W, Lewis C, Cook DR, Dobbin G, Zakriya KJ, Apple FS, Horney RA, Magaziner J. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365:2453–62.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. transfusion requirements in critical care investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999;340:409–17.

    Article  CAS  PubMed  Google Scholar 

  7. Bell RF, Dahl JB, Moore RA, Kalso E. Peri-operative ketamine for acute post-operative pain: a quantitative and qualitative systematic review (cochrane review). Acta Anaesthesiol Scand. 2005;49:1405–28.

    Article  CAS  PubMed  Google Scholar 

  8. Hocking G, Cousins MJ. Ketamine in chronic pain management: an evidence-based review. Anesth Analg. 2003;97:1730–9.

    Article  CAS  PubMed  Google Scholar 

  9. Urban MK, Ya Deau JT, Wukovits B, Lipnitsky JY. Ketamine as an adjunct to postoperative pain management in opioid tolerant patients after spinal fusions: a prospective randomized trial. HSS J. 2008;4:62–5.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA. Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am. 2007;89:526–33.

    Article  PubMed  Google Scholar 

  11. Parvizi J, Pour AE, Keshavarzi NR, D'Apuzzo M, Sharkey PF, Hozack WJ. Revision total hip arthroplasty in octogenarians. A case–control study. J Bone Joint Surg Am. 2007;89:2612–8.

    Article  PubMed  Google Scholar 

  12. Devereaux PJ, Yang H, Yusuf S, Guyatt G, Leslie K, Villar JC, Xavier D, Chrolavicius S, Greenspan L, Pogue J, Pais P, Liu L, Xu S, Malaga G, Avezum A, Chan M, Montori VM, Jacka M, Choi P. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839–47.

    Article  CAS  PubMed  Google Scholar 

  13. Urban MK, Jules-Elysee K, Loughlin C, Kelsey W, Flynn E. The one year incidence of postoperative myocardial infarction in an orthopedic population. HSS J. 2008;4:76–80.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Fleischmann KE, Beckman JA, Buller CE, Calkins H, Fleisher LA, Freeman WK, Froehlich JB, Kasper EK, Kersten JR, Robb JF, Valentine RJ. 2009 ACCF/AHA focused update on perioperative beta blockade. J Am Coll Cardiol. 2009;54:2102–28.

    Article  PubMed  Google Scholar 

  15. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, Ludwig LE, Pedan A, Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    Article  CAS  PubMed  Google Scholar 

  16. Urban MK, Wolfe S, Sangavi N, Magid S. One year incidence of postoperative myocardial infarction (PMI) in patients undergoing major orthopedic surgery (abstract). International Anesthesia Research Society: San Diego, CA; 2009.

    Google Scholar 

  17. Biccard BM, Rodseth RN. The pathophysiology of peri-operative myocardial infarction. Anaesthesia. 2010;65:733–41.

    Article  CAS  PubMed  Google Scholar 

  18. Urban MK, Markowitz SM, Gordon MA, Urquhart BL, Kligfield P. Postoperative prophylactic administration of beta-adrenergic blockers in patients at risk for myocardial ischemia. Anesth Analg. 2000;90:1257–61.

    Article  CAS  PubMed  Google Scholar 

  19. Sari A, Miyauchi Y, Yamashita S, Yokota K, Ogasahara H, Yonei A. The magnitude of hypoxemia in elderly patients with fractures of the femoral neck. Anesth Analg. 1986;65:892–4.

    CAS  PubMed  Google Scholar 

  20. Gitin TA, Seidel T, Cera PJ, Glidewell OJ, Smith JL. Pulmonary microvascular fat: the significance? Crit Care Med. 1993;21:673–7.

    Article  CAS  PubMed  Google Scholar 

  21. Urban MK, Sheppard R, Gordon MA, Urquhart BL. Right ventricular function during revision total hip arthroplasty. Anesth Analg. 1996;82:1225–9.

    CAS  PubMed  Google Scholar 

  22. Ereth MH, Weber JG, Abel MD, Lennon RL, Lewallen DG, Ilstrup DM, Rehder K. Cemented versus noncemented total hip arthroplasty–embolism, hemodynamics, and intrapulmonary shunting. Mayo Clin Proc. 1992;67:1066–74.

    Article  CAS  PubMed  Google Scholar 

  23. Schonfeld SA, Ploysongsang Y, DiLisio R, Crissman JD, Miller E, Hammerschmidt DE, Jacob HS. Fat embolism prophylaxis with corticosteroids. A prospective study in high-risk patients. Ann Intern Med. 1983;99:438–43.

    Article  CAS  PubMed  Google Scholar 

  24. Parvizi J, Mui A, Purtill JJ, Sharkey PF, Hozack WJ, Rothman RH. Total joint arthroplasty: when do fatal or near-fatal complications occur? J Bone Joint Surg Am. 2007;89:27–32.

    Article  PubMed  Google Scholar 

  25. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the second international consensus conference of the acute dialysis quality initiative (ADQI) group. Crit Care. 2004;8:R204–12.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Gupta RM, Parvizi J, Hanssen AD, Gay PC. Postoperative complications in patients with obstructive sleep apnea syndrome undergoing hip or knee replacement: a case–control study. Mayo Clin Proc. 2001;76:897–905.

    Article  CAS  PubMed  Google Scholar 

  27. Vasu TS, Doghramji K, Cavallazzi R, Grewal R, Hirani A, Leiby B, Markov D, Reiter D, Kraft WK, Witkowski T. Obstructive sleep apnea syndrome and postoperative complications: clinical use of the STOP-BANG questionnaire. Arch Otolaryngol Head Neck Surg. 2010;136:1020–4.

    Article  PubMed  Google Scholar 

  28. Memtsoudis SG, Ma Y, Gonzalez Della Valle A, Mazumdar M, Gaber-Baylis LK, MacKenzie CR, Sculco TP. Perioperative outcomes after unilateral and bilateral total knee arthroplasty. Anesthesiology. 2009;111:1206–16.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Urban MK, Chisholm M, Wukovits B. Are postoperative complications more common with single-stage bilateral (SBTKR) than with unilateral knee arthroplasty: guidelines for patients scheduled for SBTKR. HSS J. 2006;2:78–82.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Bruce AJ, Ritchie CW, Blizard R, Lai R, Raven P. The incidence of delirium associated with orthopedic surgery: a meta-analytic review. Int Psychogeriatr. 2007;19:197–214.

    Article  PubMed  Google Scholar 

  31. Allen SR, Frankel HL. Postoperative complications: delirium. Surg Clin North Am. 2012;92:409–31.

    Article  PubMed  Google Scholar 

  32. Urban MK, Magid S, Mangini M. One year incidence for admission to a critical care unit after major orthopedic surgery (abstract), 7th annual perioperative medicine summit. Miami, FL; 2011.

    Google Scholar 

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Correspondence to Michael K. Urban .

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Urban, M.K. (2014). The Role of the Post-anesthesia Care Unit in the Perioperative Care of the Orthopedic Patient. In: MacKenzie, C., Cornell, C., Memtsoudis, S. (eds) Perioperative Care of the Orthopedic Patient. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0100-1_8

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  • DOI: https://doi.org/10.1007/978-1-4614-0100-1_8

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