Anestesia en cirugía de cadera

Manejo perioperatortio de agentes antiplaquetarios y antitrombóticos en ancianos sometidos a cirugía de cadera semiurgente Peri-operative management of anti-platelet agents and anti-thrombotic agents in geriatric patients undergoing semi-urgent hip fracture surgery. Ho HH, Lau TW, Leung F, Tse HF, Siu CW. Department of Cardiology, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore, Singapore. hokai_wah@yahoo.com Osteoporos Int. 2010 Dec;21(Suppl 4):S573-7. Epub 2010 Nov 6. Abstract Hip fractures are common events in the geriatric population and are often associated with significant morbidity and mortality. Over the coming decades, the size of the greying population is forecast to increase and hence, the annual incidence of hip fracture is expected to rise substantially. Several studies have shown that hip fracture surgery performed within 24 to 48 h of hospitalisation significantly reduces mortality. Medical specialists including cardiologists are often involved in the care of these geriatric patients as most of them have comorbid conditions that must be managed concomitantly with their fracture. Cardiovascular and thromboembolic complications are among some of the commonest adverse events that could be experienced by these elderly patients during hospitalisation. We review in this article the current recommendations and controversies on the peri-operative management of anti-platelet agents and anti-thrombotic agents in geriatric patients undergoing semi-urgent hip fracture surgery. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974916/ pdf/198_2010_Article_1416.pdf   Estudio comparativo de dos técnicas de anestesia de acuerdo con las complicaciones postoperatorias y mortalidad a un mes en candidatos a cirugía de cadera Comparative study of two anesthesia methods according to postoperative complications and one month mortality rate in the candidates of hip surgery. Heidari SM, Soltani H, Hashemi SJ, Talakoub R, Soleimani B. Associate Professor of Anesthesiology, School of Medicine and Anesthesiaology and Critical Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran. J Res Med Sci. 2011 Mar;16(3):323-30. Abstract BACKGROUND: Surgery for hip fractures can be done under general or neuraxial anesthesia. This study aimed to compare these two methods concerning their postoperative complications, duration of operation, hospitalization and the mortality rate within a period of one month after surgery.METHODS: 400 patients aged more than 30 years old and scheduled for elective operative fixation of fractured hip, randomly enrolled in two equal groups of general (GA) and neuraxial (NA) anesthesia. Hemoglobin level was measured before and 6 hours, 2, 3 and 5 days after the surgery. The intra and postoperative blood loss, duration of surgery, the severity of pain at the time of discharge from recovery and at the 2(nd), 3(rd) and 5(th) postoperative days were recorded. Statistical analysis was performed using SPSS version 12.0 by Mann-Whitney, chi-square, and t tests. P < 0.05 was considered significant. RESULTS: Both groups were similar regarding age, weight, and gender ratio. There was no significant difference in baseline hemoglobin, duration of surgery, length of hospitalization before surgery and the type of surgery. The mean of intraoperative blood loss and visual analogue score (VAS) in recovery and at the 3(rd) postoperative day, and also the length of hospitalization after surgery were significantly less in neuraxial anesthesia group. Both groups showed a significant decrease in hemoglobin values on the 2(nd) and 3(rd) postoperative days comparing to the baseline (p < 0.001). CONCLUSIONS: The morbidity and mortality rates of patients undergoing hip surgery were similar in both methods of anesthesia, but postoperative pain, blood loss, and duration of hospitalization were more in patients undergoing general anesthesia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214341/

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