The use of point-of-care ultrasound to diagnose patent foramen ovale in elective hip and knee arthroplasty patients and its association with postoperative delirium

Gai, Nan; Lavi, Ron; Jones, Philip M.; Lee, Hwa; Naudie, Douglas D.R.; Bainbridge, Daniel

doi:10.1007/s12630-018-1073-7

Cited by 7 publications

(11 citation statements)

References 15 publications

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“…In addition, hip and knee arthroplasty surgeries are associated with the embolism of materials such as air, cement, and fat. Considering this, some researchers investigated a possible correlation between the number of emboli and POD, with their studies showing no statistically significant results [3,67].…”

Section: Pathophysiology and Biomarkersmentioning

confidence: 99%

“…Delirium and postoperative cognitive dysfunction are such, with their numbers increasing due to the increasing number of THAs and TKAs performed. Every physician involved in the care of postoperative (post-op) THA and TKA patients should be informed on every aspect of these conditions in order to provide the best care for their patients [1][2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature

Kitsis

Zisimou

Gkiatas

et al. 2022

Life

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Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are common complications following total knee arthroplasty (TKA) and total hip arthroplasty (THA), affecting the length of hospital stay and increasing medical complications. Although many papers have been published on both conditions in this setting, no reviews have currently been written. Thus, the purpose of our study is to summarize the current literature and provide information about POD and POCD following elective THA or TKA. Our literature search was conducted in the electronic databases PubMed and the Cochrane library. We found that POD is a common complication following elective THA or TKA, with a median incidence of 14.8%. Major risk factors include older age, cognitive impairment, dementia, preoperative (pre-op) comorbidities, substance abuse, and surgery for fracture. Diagnosis can be achieved using tools such as the confusion assessment method (CAM), which is sensitive, specific, reliable, and easy to use, for the identification of POD. Treatment consists of risk stratification and the implementation of a multiple component prevention protocol. POCD has a median incidence of 19.3% at 1 week, and 10% at 3 months. Risk factors include older age, high BMI, and cognitive impairment. Treatment consists of reversing risk factors and implementing protocols in order to preserve physiological stability. POD and POCD are common and preventable complications following TKA and THA. Risk stratification and specific interventions can lower the incidence of both syndromes. Every physician involved in the care of such patients should be informed on every aspect of these conditions in order to provide the best care for their patients.

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Section: Pathophysiology and Biomarkersmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature

Kitsis

Zisimou

Gkiatas

et al. 2022

Life

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“…Kontrolisanom hipotenzijom, održavajući srednji arterijski pritisak od 50 do 60 mmHg, smanjuje se ne samo intraoperativno krvarenje na svega 200 ml nego se obezbeđuje i bolja fiksacija između proteze i kosti, zbog manjeg krvarenja iz femoralnog kanala 42 . Međutim, primećeno je da stariji pacijenti ne mogu da tolerišu ove vrednosti srednjeg arterijskog pritiska bez postoperativnih kognitivnih, kardioloških i renalnih komplikacija 43 . Cementna fiksacija proteze može da dovede do nastanka hipotenzije, hipoksije i srčanog zastoja, kao i sindroma masne embolije (fat embolism syndrome -FES) postoperativno.…”

Section: Artoplastike Kukaunclassified

“…Cementna fiksacija proteze može da dovede do nastanka hipotenzije, hipoksije i srčanog zastoja, kao i sindroma masne embolije (fat embolism syndrome -FES) postoperativno. Nekoliko mehanizama mogu biti razlog tome, uključujući i embolizaciju cirkulacije ostacima koštane srži tokom obrade femoralnog kanala, koja se smatra najverovatnijom, zbog mogućnosti vizuelizacije ostataka u desnoj komori srca, ali i toksičnim efektom metil metakrilat monomera u cirkulaciji i oslobađanja citokina tokom obrade femoralnog kanala 42,43 .…”

Section: Artoplastike Kukaunclassified

Anesthesia and perioperative medicine in orthopedic surgery

Srećković¹,

Milovanovic²,

Stojimanovska³

et al. 2019

Serb J Anest Inten Therapy

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Ortopedska hirurgija danas predstavlja veliki izazov za anesteziologe sa aspekta stanja pacijenta, tipa operacije, kao i položaja koji pacijent zauzima u toku operacije. U skladu sa trendom porasta gerijatrijske populacije, ortopedski pacijenti su najčešće stari sa brojnim komorbiditetima, ali i mladi, zdravi, najčešće traumatizovani, kod kojih postojanje udruženih povreda ima značajan uticaj na izbor tipa anestezije. Prilikom izbora tipa anestezije kod ortopedskih pacijenata neophodno je da se napravi adekvatna preoperativna procena i priprema i da se sagleda celokupno stanje pacijenta, a ne samo deo od značaja za hirurgiju. U okviru preoperativne pripreme kod ortopedskih pacijenata je najčešće neophodna kardiološka, pulmološka, ali i neurološka evaluacija, zatim nazalni skrining i dekolonizacija, preoperativna priprema kože, kontrola glikemije, kao i primena antibiotske profilakse. Ortopedska hirurgija ima najveći rizik za nastanak venskog tromboembolizma. Pravovremeno započinjanje tromboprofilakse, kao i njen nastavak posle operacije, kod ortopedskih pacijenata je od izuzetnog značaja. Za optimalnu upotrebu adekvatne tromboprofilakse postoji nekoliko objavljenih vodiča sa jasnim preporukama za dnevnu kliničku praksu. Poznavanje specifičnosti operacije, toka hirurgije, kao i položaja koji pacijent zauzima omogućava obezbeđivanje adekvatnih uslova rada uz minimalne gubitke krvi i komplikacije. Smanjenje krvarenja, kako intraoperativno tako i postoperativno, postiže se normovolemijskom hipotenzijom, bledom stazom uz pomoć poveske (touriquet), ali i primenom traneksamične kiseline, bilo sistemski ili lokalno. Kao hirurgija sa velikim postoperativnim zahtevima u analgeziji, u okviru multimodalnog pristupa se sve češće, pored perifernih nervnih blokova, u svakodnevnom radu primenjuje i periartikularno ubrizgavanje lokalnog anestetika. Poznavanje specifičnosti, ali i zahteva ortopedske operacije sa adekvatnom preoperativnom pripremom, iz-Revijalni članak

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“…16 Point-of-care ultrasound in the anesthesiologist's or intensivist's hands assists in the evaluation of clinically important RLSs, such as in severe refractory hypoxemia or paradoxical embolism. 17 Early POCUS evaluation for patients with end-stage heart failure is important to assess for left ventricular assist device (LVAD) candidacy. 18 The physiology associated with an LVAD includes reduced left heart filling pressures and may precipitate RLS and hypoxemia in patients with a PFO.…”

mentioning

confidence: 99%

Point-of-care echocardiography for the evaluation of right-to-left cardiopulmonary shunts: a narrative review

Montrief

Alerhand

Denault

et al. 2020

Can J Anesth/J Can Anesth

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The use of point-of-care ultrasound to diagnose patent foramen ovale in elective hip and knee arthroplasty patients and its association with postoperative delirium

Abstract: ClinicalTrials.gov (NCT02400892). Registered 27 March 2015.

Cited by 7 publications

References 15 publications

Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature

Postoperative Delirium and Postoperative Cognitive Dysfunction in Patients with Elective Hip or Knee Arthroplasty: A Narrative Review of the Literature

Anesthesia and perioperative medicine in orthopedic surgery

Point-of-care echocardiography for the evaluation of right-to-left cardiopulmonary shunts: a narrative review

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