scholarly journals Intra‐individual variability in processed EEG (bispectral index monitor) under general anesthesia predicts postoperative cognitive change after total knee arthroplasty

2021 ◽  
Vol 17 (S6) ◽  
Author(s):  
Catherine Dion ◽  
Jared J. Tanner ◽  
Carlos Hernaiz ◽  
Hari K. Parvataneni ◽  
Catherine C. Price
Keyword(s):  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Bispectral Index ◽  
Cognitive Change ◽  
Individual Variability ◽  
Processed Eeg ◽  
Total Knee ◽  
Bispectral Index Monitor

scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

A Comparison of Neuraxial and General Anesthesia for Thirty-Day Postoperative Outcomes in United States Veterans Undergoing Total Knee Arthroplasty

2020 ◽  
Vol 35 (11) ◽  
pp. 3138-3144
Author(s):  
Mohanad Baldawi ◽  
George McKelvey ◽  
Wael Saasouh ◽  
Sameul Perov ◽  
Gamal Mostafa ◽  
...  
Keyword(s):  
United States ◽  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Postoperative Outcomes ◽  
Total Knee

Inpatient Falls after Total Knee Arthroplasty

2014 ◽  
Vol 120 (3) ◽  
pp. 551-563 ◽  
Author(s):  
Stavros G. Memtsoudis ◽  
Thomas Danninger ◽  
Rehana Rasul ◽  
Jashvant Poeran ◽  
Philipp Gerner ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Odds Ratio ◽  
Orthopedic Procedures ◽  
Inpatient Falls ◽  
Total Knee ◽  
Anesthesia Technique

Abstract Background: Much controversy remains on the role of anesthesia technique and peripheral nerve blocks (PNBs) in inpatient falls (IFs) after orthopedic procedures. The aim of the study is to characterize cases of IFs, identify risk factors, and study the role of PNB and anesthesia technique in IF risk in total knee arthroplasty patients. Methods: The authors selected total knee arthroplasty patients from the national Premier Perspective database (Premier Inc., Charlotte, NC; 2006–2010; n = 191,570, &gt;400 acute care hospitals). The primary outcome was IF. Patient- and healthcare system–related characteristics, anesthesia technique, and presence of PNB were determined for IF and non-IF patients. Independent risk factors for IFs were determined by using conventional and multilevel logistic regression. Results: Overall, IF incidence was 1.6% (n = 3,042). Distribution of anesthesia technique was 10.9% neuraxial, 12.9% combined neuraxial/general, and 76.2% general anesthesia. PNB was used in 12.1%. Patients suffering IFs were older (average age, 68.9 vs. 66.3 yr), had higher comorbidity burden (average Deyo index, 0.77 vs. 0.66), and had more major complications, including 30-day mortality (0.8 vs. 0.1%; all P &lt; 0.001). Use of neuraxial anesthesia (IF incidence, 1.3%; n = 280) had lower adjusted odds of IF compared with adjusted odds of IF with the use of general anesthesia alone (IF incidence, 1.6%; n = 2,393): odds ratio, 0.70 (95% CI, 0.56–0.87). PNB was not significantly associated with IF (odds ratio, 0.85 [CI, 0.71–1.03]). Conclusions: This study identifies several risk factors for IF in total knee arthroplasty patients. Contrary to common concerns, no association was found between PNB and IF. Further studies should determine the role of anesthesia practices in the context of fall-prevention programs.

Highly Satisfied Total Knee Arthroplasty Patients Display a Wide Range of Soft Tissue Balance

2019 ◽  
Vol 33 (03) ◽  
pp. 247-254 ◽  
Author(s):  
Michael J. McAuliffe ◽  
Patrick B. O'Connor ◽  
Lisa J. Major ◽  
Gautam Garg ◽  
Sarah L. Whitehouse ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Soft Tissue ◽  
Knee Arthroplasty ◽  
Individual Variability ◽  
Measured Parameter ◽  
Computer Assisted ◽  
Maximum Extension ◽  
Wide Range ◽  
Coronal Laxity ◽  
Total Knee

AbstractSoft tissue balancing while crucial for a successful total knee arthroplasty (TKA) is incompletely defined and the subject of broad recommendations. We analyzed 69 unilateral computer-assisted surgery posterior stabilized (PS) TKA subjects who postoperatively scored ≥36 out of a possible 40 points on the satisfaction section of the American Knee Society score (2011). We examined a range of postoperative coronal plane laxity parameters and the correlation between preoperative and postoperative laxity. Total postoperative coronal laxity arcs at maximum extension and 20 degrees of flexion varied between 2 and 12 and 3 and 13 degrees, respectively. Depending on the position of measurement, medial laxity was between 0.5 and 9.5 degrees and lateral laxity between 1 and 12 degrees. The change in laxity between maximum extension and 90 degrees of flexion demonstrated a range of 7 degrees medially and 12 degrees laterally. The total coronal arc of movement did not affect functional outcomes. A moderate correlation of 0.452 and 0.424 was seen between initial and postoperative total coronal laxity arcs in maximum extension and 20 degrees of flexion, respectively. The individual variability for each measured parameter within our cohort demonstrates TKA satisfaction is not as simple as producing a narrow range of coronal laxity parameters and that as with many body systems considerable variation is still consistent with excellent function. Our findings help to define acceptable balance parameters for PS TKA. It does not appear necessary to closely match postoperative laxity to that present preoperatively.

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