Intraoperative Hemodynamic Changes during Total Knee Replacement

Samii, Kamran; Elmelik, E; Mourtada, Mohamed B.; Debeyre, J; Rapin, M

doi:10.1097/00000542-197903000-00016

Cited by 23 publications

(19 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transesophageal echocardiography during the course of conventional IM instrumented total knee procedures has demonstrated showers of fat or intramedullary embolic particles enter the right atrium of the heart in repeated and unpredictable patterns [5,6,10,12,20,22,25,28,29,39,41,42,[48][49][50]57]. Most often these are clinically unimportant.…”

Section: Introductionmentioning

confidence: 99%

Less Invasive TKA

Baldini

Adravanti

2008

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Less Invasive TKA

Baldini

Adravanti

2008

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…Three other patients with Schonfeld score greater than 5, which would qualify them as having fat embolism syndrome, had PAC monitoring which failed to show any change in PAP. Dorr et al, in a group of 79 patients undergoing BTKR recommended that an increase in PVR above 200 dyne/s/cm 3 , or a doubling of PVR should lead to cancellation of the second knee [9]. Of note is that none of the patients with such findings went on to develop FES.…”

Section: Discussionmentioning

confidence: 99%

“…Bilateral total knee replacement (BTKR) has been associated with a higher incidence of fat embolism syndrome (FES) compared to single total knee replacement [1][2][3]. Since an increase in pulmonary arterial pressure (PAP) is an early sign of FES, it has been recommended that patients undergoing BTKR be monitored with a pulmonary artery catheter (PAC) to detect any elevation in PAP suggestive of FES prior to proceeding with surgery on second knee [4].…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Artery versus Central Venous Catheter Monitoring in the Outcome of Patients Undergoing Bilateral Total Knee Replacement

Jules-Elysée

YaDeau

Urban

2009

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

View full text Add to dashboard Cite

Bilateral total knee replacement (BTKR) has been associated with a higher incidence of fat embolism (FES) compared to single knee replacement. Consequently, intraoperative monitoring with a pulmonary artery catheter (PAC) has been recommended. This study compares clinical outcome in BTKR patients monitored with central venous pressure versus PAC. A retrospective chart review of 249 consecutive patients undergoing BTKR, 132 of whom had PAC insertion versus 117 who had central line insertion, over a 1-year period were included in the study. Their medical records were reviewed for co-morbidities, baseline characteristics, and type of intraoperative monitoring. Need and duration for postoperative monitoring in the postoperative care, length of hospital stay (LOHS), signs of fat embolism, development of arrhythmias, and respiratory failure were all outcome measures. A total of four patients (1.6%) had FES as per Schonfeld criteria. One of these patients died within 48 h of surgery. They all had PAC monitoring intraoperatively. Pulmonary artery pressure (PAP) remained unchanged during surgery which raises doubt as to the clinical utility and advisability of the use of PAC's in this setting. There was no statistically significant difference in cardiac or pulmonary complications, or LOHS between the two groups. Central venous pressure monitoring appears to be sufficient in patients undergoing BTKR.

show abstract

“…At this step, blood pressure and HR were recorded for 6 min because previous reports have suggested that the nadir of the blood pressure occurred within 5 min after tourniquet deflation. 1,[8][9][10] In the control group, the tourniquet was deflated while the patient's legs remained in the supine position and haemodynamic measurements were obtained at points corresponding to those in the PLR patients. Step 1…”

Section: Methodsmentioning

confidence: 99%

“…After tourniquet deflation, the blood volume shifts back to the ischaemic limb, thereby reducing cardiac preload, which may lead to hypotension. 1 Such hypotension can be profound and has been reported to result in tachycardia and cardiac arrest. 2,3 It is therefore crucial to maintain haemodynamic stability after tourniquet deflation.…”

Section: Introductionmentioning

confidence: 99%