Anaesthesia for Total Hip Replacement

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  • Anaesthesia for Total Hip Replacement
A patient who is indicated for total hip replacement surgery on the right hip joint due to coxarthrosis is now lying on the operating table. The patient is sixty-nine-year-old Mr Kulhal who had a preoperative examination performed by medical dictor before the surgery (results see below), and also an examination at an anaesthetic out patient department, where the anaeshetist recommended preoperative discontinuation of the ACE inhibitor and a premedication by Lexaurin 3.0 mg PO. Autologous blood transfusion was not indicated. What type of anaesthesia is appropriate for this type of procedure?

Regional anaesthesia.

Correct answer

Regional anaesthesia is one of the possibilities of conducting anaesthesia in total hip replacement procedure. Spinal anaesthesia causing muscle relaxation is especially suitable and can be combined with peripheral nerve blockade. Epidural anaesthesia is also a possibility, however, muscle relaxation is less significant. THR surgery may also be performed in general anaesthesia.


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No anaesthesia is required.

Incorrect answer

Performing this surgery without any anaesthesia can not be considered!


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General anaesthesia.

Correct answer

General anaesthesia is one of the possibilities of conducting anaesthesia in hip replacement surgery. We prefer it when more significant blood loss is expected during surgery or we expect a long term operation. It can be supplemented with an epidural catheter when necessary, for continuous epidural analgesia. Hip replacement can also be performed in regional anaesthesia.


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Local anaesthesia.

Incorrect answer

In case of local infiltration anaesthesia local anesthetics are injected directly into the area of the performed procedure. It is used mainly in dentistry and excision of small skin affections.


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THR - Total Hip Replacement
Lexaurin - active substance bromazepam
In the Department of Transfusion and Tissue Medicine of the Brno University Hospital is autologous blood transfusion not performed in patients with the level of haemoglobin of more than 150 g/L.×
 
RR

17 bpm

HR

79 bpm

SpO2

97 %

BP

131/81 mmHg

ECG

sinus rhythm, regular rate, frequency 79 bpm, ST segment normal, no arrhythmia

Examination:
Examination:
PH: hypertension diagnosed 5 years ago (compensated), compensated DM type II, hyperlipidaemia
Medication: Perindopril (ACE inhibitor), Atorvastatin
Allergies: Acetylsalicylic acid (ASA)
Abuse: used to smoke 8-10 cigarettes per day, quit smoking 15 years ago, negates other addictive substances
Mallampati classification: class II
Chest X-ray: normal
INR 1.1; APTTR 0.9
Height: 173 cm
weight: 93 kg

glc

Results

ABG

not available

CBC

Results

biochem.analysis

Results