Osobitosti anestezije kod ortopedskih zahvata u bolesnika s osteogenesis imperfecta [Characteristics of anesthesia in patients with osteogenesis imperfecta undergoing orthopedic surgical procedures]

The aim is to show our experience in anesthesia of patients with osteogenesis imperfecta (OI) who have undergone orthopedic surgical procedures. This is a retrospective analysis of OI patients treated at our Department from 1980 to 2012. We analyzed demographics, comorbidities, preoperative characteristics, anesthesia types, anesthetics and intraoperative and postoperative complications. In the given period, 26 OI patients were treated, using 103 surgeries, and 103 anesthesia procedures. Most procedures, a total of 68, were used in children aged 0-10 years. According to the diagnosis, OI type III was mostly encountered. The rating of the American Society of Anesthesiologist (ASA) physical status was II in most cases, a total of 99. General anesthesia was used in 89 cases, and regional anesthesia in 14. Fourteen intraoperative complications were seen, mostly difficult intubation, and six postoperative cardiovascular instability cases. With careful preparation, and knowledge of pitfalls, anesthesia in these patients should be a safe procedure

CHARACTERISTICS OF ANESTHESIA IN PATIENTS WITH OSTEOGENESIS IMPERFECTA UNDERGOING ORTHOPEDIC SURGICAL PROCEDURES

Prikazujemo svoje iskustvo u anesteziranju bolesnika s osteogenesis imperfectom u sklopu ortopedskoga kirurškog liječenja prijeloma i deformacija kostiju. Učinjena je retrospektivna analiza dokumentacije bolesnika liječenih u našoj Klinici od 1980. do 2012. godine. Analizirani su demografski podaci, komorbiditeti, prijeoperacijske osobitosti, vrste anestezije, anestetika i lijekova te intraoperacijske i poslijeoperacijske komplikacije. U navedenom razdoblju liječeno je 26 bolesnika s navedenom dijagnozom. Zabilježene su 103 operacije, odnosno 103 anesteziološka postupka. Najviše zahvata, njih 68, učinjeno je u dobnoj skupini od 0 do 10 godina. Najviše bolesnika bolovalo je od tipa III osteogenesis imperfecte, najtežeg oblika ove bolesti spojivog sa životom. U 99 operacija zabilježen je ASA (American society of anesthesiologists) status II bolesnika. U 89 slučajeva učinjena je opća anestezija, u 14 regionalna. Zabilježeno je 14 intraoperacijskih komplikacija, najviše otežanih intubacija te 6 slučajeva poslijeoperacijske kardiovaskularne nestabilnosti. Uz kvalitetnu pripremu i predviđanje mogućih komplikacija anestezija u ovih bolesnika sigurna je procedura.The aim is to show our experience in anesthesia of patients with osteogenesis imperfecta (OI) who have undergone orthopedic surgical procedures. This is a retrospective analysis of OI patients treated at our Department from 1980 to 2012. We analyzed demographics, comorbidities, preoperative characteristics, anesthesia types, anesthetics and intraoperative and postoperative complications. In the given period, 26 OI patients were treated, using 103 surgeries, and 103 anesthesia procedures. Most procedures, a total of 68, were used in children aged 0–10 years. According to the diagnosis, OI type III was mostly encountered. The rating of the American Society of Anesthesiologist (ASA) physical status was II in most cases, a total of 99. General anesthesia was used in 89 cases, and regional anesthesia in 14. Fourteen intraoperative complications were seen, mostly difficult intubation, and six postoperative cardiovascular instability cases. With careful preparation, and knowledge of pitfalls, anesthesia in these patients should be a safe procedure

Utjecaj tromboprofilakse fondaparinuksom u usporedbi s nadroparin kalcijem na kliničke parametre nakon ugradnje potpune endoproteze koljena

Fondaparinux has been shown to be as effective as low molecular weight heparin in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. The main goal of this prospective randomized controlled trial was to define whether thromboprophylaxis in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) influences clinical parameters in the same manner in patients receiving fondaparinux as in those receiving nadroparin during the first 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent unilateral TKA performed by the same surgeon and were randomized into two groups of 30 patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation of the edema during the early postoperative period. No diff erences were found between the groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. The level of urea was significantly lower in the nadroparin group on the first and second postoperative day. No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were noted during the study. Study results showed both fondaparinux and nadroparin to have the same influence on clinical parameters during the first 7 postoperative days in patients undergoing TKA.Fondaparinuks se pokazao jednako učinkovitim u ortopedskim operacijama kao i heparin niske molekularne težine, bez slučajeva heparinom izazvane trombocitopenije do danas. Glavni cilj ovoga prospektivnog randomiziranog istraživanja bio je pokazati utječe li tromboprofilaksa fondaparinuksom na bolesnike s primarnom gonartrozom koji su podvrgnuti operacijskom zahvatu ugradnje totalne endoproteze koljena na jednaki način kao i nadroparin tijekom prvih 7 dana nakon operacije. Ukupno 60 bolesnika kod kojih je jednostranu ugradnju totalne endoproteze koljena izveo jedan te isti operater randomizirani su u dvije skupine po 30 bolesnika te je jedna skupina dobivala tromboprofilaksu fondaparinuksom, a druga nadroparinom. Bolesnici su uspoređivani prema trajanju operacije, perioperacijskom gubitku krvi, laboratorijskim nalazima te kliničkoj evaluaciji edema tijekom ranog poslijeoperacijskog razdoblja. Nisu nađene razlike u trajanju operacijskog zahvata, perioperacijskom gubitku krvi niti prema većini laboratorijskih nalaza. Razina ureje je bila značajno niža u skupini s nadroparinom tijekom prva dva poslijeoperacijska dana. Nije zabilježen niti jedan slučaj heparinom izazvane trombocitopenije, duboke venske tromboze ili plućne embolije tijekom ovog istraživanja. Naši rezultati pokazali su da fondaparinuks i nadroparin na isti način utječu na kliničke parametre tijekom prvih 7 poslijeoperacijskih dana od ugradnje totalne endoproteze koljena

Influence of fondaparinux versus nadroparin calcium thromboprophylaxis on clinical parameters following total knee arthroplasty

Fondaparinux has been shown to be as effective as low molecular weight heparin in orthopedic surgery, with no cases of heparin induced thrombocytopenia proven until today. The main goal of this prospective randomized controlled trial was to define whether thromboprophylaxis in patients with primary osteoarthritis of the knee undergoing total knee arthroplasty (TKA) influences clinical parameters in the same manner in patients receiving fondaparinux as in those receiving nadroparin during the first 7 postoperative days. Sixty patients with primary knee osteoarthritis underwent unilateral TKA performed by the same surgeon and were randomized into two groups of 30 patients receiving either fondaparinux or nadroparin thromboprophylaxis. Patients were compared according to the duration of operation, perioperative blood loss, laboratory results and clinical evaluation of the edema during the early postoperative period. No diff erences were found between the groups in the mean duration of surgery, perioperative blood loss, and most of laboratory results. The level of urea was significantly lower in the nadroparin group on the first and second postoperative day. No cases of heparin induced thrombocytopenia, deep vein thrombosis or pulmonary embolism were noted during the study. Study results showed both fondaparinux and nadroparin to have the same influence on clinical parameters during the first 7 postoperative days in patients undergoing TKA

Two different dosing regimens of human recombinant erythropoietin beta during preoperative autologous blood donation in patients having hip arthroplasty

PURPOSE: Our aim was to evaluate the effectiveness of two different dosing regimens of human recombinant erythropoietin (rHu-EPO) for preoperative autologous blood collection in patients undergoing total hip arthroplasty (THA). ----- METHODS: Prospective randomised trials in which erythropoietin 15,000 IU was administered intravenously twice a week or 30,000 IU once a week (total 90,000 IU) combined with ferrous II sulphate (Ferro-Gradumet 2) orally and compared with Ferro-Gradumet 2 alone. ----- RESULTS: Although different dosing regimens of rHu-EPO administration during preoperative autologous blood donation have similar effects on the collection of two units of autologous blood, preoperative haemoglobin level and perioperative allogenic blood transfusion, a once weekly dose regimen of rHu-EPO was more convenient (although not statistically significantly) for patients. ----- CONCLUSION: We recommend the more practical and comfortable but yet highly effective therapeutic regimen with a single weekly intravenous administration of rHu-EPO for patients scheduled for THA