General anaesthesia and total hip replacement

Abstract

TOTAL HIP REPLACEMENT has become a frequent procedure since the initial work of Charnley, McKee, Watson, Ferrar and Ring in the early 1960s. The most popular technique, that of Miiller, ~ involves a socket prosthesis fixed in the acetabulum with acrylic bone cement. A femoral prosthesis is then fixed in the medullary cavity with the same acrylic cement. Peroperative complications associated with prosthesis implantation have ranged from transient hypotension, 8 cardiac arrest, 4 and embolic phenomena TM to significant decreases in arterial oxygen tension, s,9 This study is an attempt to review the clinical management of these patients with particular attention to their needs during operation. An attempt is also made to assess the significance of variations of the cardiovascular and pulmonary gas exchange which are associated with the use of acrylic bone cement. Alveolararterial oxygen gradients (A-aDO2), arterio-alveolar carbon dioxide gradients (a-ADCO2), and venous admixture (Qs/Qt) are used to assess these variations.

Pulmonary and Circulatory Reactions During Total Hip Replacement Surgery

“…Received 20 January, acce@ted,for publication 4 February 1975 During total hip replacement in man, several investigations have revealed a transient reduction of arterial blood pressure, occurring mainly after the insertion of bone cement and insertion of the prosthesis into the femoral marrow cavity (PHILLIPS et al 1971, KIM & RITTER 1972, SOMMERLAD 1972, SCHUI~ et al 1973. Recently there have also been reports of depression of the arterial oxygen tension in connection with the implantation of cement and implantation of the prosthesis into the marrow cavity in man (PARK et al 1973, TURNBULL et al 1974. I n previous investigations these phenomena have been confirmed, and suggestions as to their causative mechanisms have been put forth (MODIG et al 1973a(MODIG et al , 1975.…”

Perioperative management of a patient with a malignant pheochromocytoma

“…Several mechanisms have been proposed to account for this effect. [6][7][8] Epidural anaesthesia has been used safely for management of pheochromocytoma. 9-10 The technique permits a final assessment of sympathetic blockage prior to surgery.…”

Assessment of the cardiopulmonary functions during total hip arthroplasty in the dog

“…Other pulmonary complications that have also been reported are pulmonary capillary leaks (Safwat and Dror, 1982), an increased venous admixture (Tumbull et al, 1974;Modig and Molmberg, 1975;Modig, 1976), pulmonary hypertension, and elevated pulmonary vascular resistance (Modig and Molmberg, 1975;Rinecker, 1980). Contrary to previously reported pulmonary complications, Hughes et al (1972) reported no evidence of pulmonary dysfunction after THA with PMM in man.…”