Comparison of general and spinal anesthesia and their influence on hemostatic markers in patients undergoing total hip arthroplasty

Brueckner, Sabine; Reinke, Ulrike; Roth-Isigkeit, Angela; Eleftheriadis, S.; Schmucker, P.; Siemens, Hans-Joachim G

doi:10.1016/s0952-8180(03)00082-5

Cited by 31 publications

(27 citation statements)

References 31 publications

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“…Perioperative outcomes of anesthesia in hip surgery coagulation parameters were reported as not significantly altered from baseline [45] . Observational studies have failed to this day to show differences in homeostatic markers undergoing general or neuraxial anesthesia, leaving the reasons for the observed clinical differences to be discussed and studied [46] .…”

Section: Blood Loss and Transfusion Needmentioning

confidence: 99%

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

Opperer

Danninger

Stundner

et al. 2014

WJO

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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 further. Concurrent with demographic changes the affected population is burdened by an increase in average comorbidity and serious complications. It has been suggested that the choice of anesthesia not only affects the surgery setting but also the perioperative outcome as a whole. Therefore different approaches and anesthetic techniques have been developed to offer individual anesthetic and analgesic care to hip surgery patients. Recent 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 anesthesia. In this review we aim to give an overview of anesthetic techniques in use for hip surgery and their impact on perioperative outcome. While 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 general anesthesia. Much 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.

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Section: Blood Loss and Transfusion Needmentioning

confidence: 99%

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

Opperer

Danninger

Stundner

et al. 2014

WJO

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“…TAT is a sensitive marker for thrombin formation, and its elevation in plasma is suggested to alter hemostatic activation. However, TAT formation represents only an indirect measurement of an activated coagulation system [16], and is frequently influenced by peripheral blood sampling techniques under venous occlusion. Thus, measurement of TAT has a low diagnostic accuracy for thrombotic events [17], though marked and persistent TAT level increases may deserve further investigation.…”

Section: Thrombin-antithrombin Complex (Tat)mentioning

confidence: 99%

“…Highly invasive surgery has been shown to commonly result in a hypercoagulable state [16,29], resulting in elevated plasma SF. SF reflects acute intravascular fibrin formation as well because SF is one of the circulating materials contributing to fibrin clots [30].…”

Section: Fibrinolysis and Thrombolysis 170mentioning

confidence: 99%

Coagulation and Fibrinolysis Markers and Their Use for the Prediction of High Risk Patients with Venous Thromboembolism Following Total Hip Arthroplasty

Inaba¹,

Yukizawa²,

Saito³

2014

Fibrinolysis and Thrombolysis

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“…It is hypothesised that regional anaesthesia results in vasodilatation of the lower limbs and, thus, the increased blood flow to the lower limbs seems to alter the coagulability and viscosity of blood [47]. However, the lesser risk of postoperative deep vein thrombosis in regional anaesthesia patients undergoing total hip arthroplasty is not reflected in the course of plasmatic molecular markers of haemostasis [78]. In newer studies, once-modern thromboprophylaxis was used, the protective effect of regional anaesthesia against thromboembolic events became less obvious [54].…”

Section: Deep Venous Thrombosismentioning

confidence: 99%

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

Luger

Kammerlander

Gosch³

et al. 2010

Osteoporos Int

173

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The influence of the mode of anaesthesia on outcome of geriatric patients with hip fractures is a controversial issue in the medical literature. In the light of an ageing society, a conclusive answer to this question is of growing importance. The purpose of this review was to assess the effect of neuroaxial and general anaesthesia on mortality and morbidity in geriatric patients sustaining a hip fracture. Following a current literature search within the Pubmed and Cochrane database (1967-2010), 34 randomised controlled trials, 14 observational studies and eight reviews/meta-analysis publications were included. Potentially outcome-influencing factors such as mortality, deep vein thrombosis, pulmonary embolism, postoperative confusion and other anaesthesia-related outcomes were evaluated. After analysing the current literature with 56 references, covering 18,715 patients with hip fracture, it can be concluded that spinal anaesthesia is associated with significantly reduced early mortality, fewer incidents of deep vein thrombosis, less acute postoperative confusion, a tendency to fewer myocardial infarctions, fewer cases of pneumonia, fatal pulmonary embolism and postoperative hypoxia. General anaesthesia has the advantages of having a lower incidence of hypotension and a tendency towards fewer cerebrovascular accidents compared to neuroaxial anaesthesia. Otherwise, general anaesthesia and respiratory diseases were significant predictors of morbidity in hip fracture patients. These data suggest that regional anaesthesia is the preferred technique, but the limited evidence available does not permit a definitive conclusion to be drawn for mortality or other outcomes. For hip fracture surgery, the choice of anaesthesia (general or neuroaxial) is made by the anaesthesiologist and is based on the patient's preference, comorbidities, potential general postoperative complications and the clinical experience of the anaesthesiologist. The overall therapeutic approach in hip fracture care should be determined jointly by the orthopaedic surgeon, the geriatrician and the anaesthesiologist (multidisciplinary approach).

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Comparison of general and spinal anesthesia and their influence on hemostatic markers in patients undergoing total hip arthroplasty

Cited by 31 publications

References 31 publications

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

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

Coagulation and Fibrinolysis Markers and Their Use for the Prediction of High Risk Patients with Venous Thromboembolism Following Total Hip Arthroplasty

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

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