Fast-Track Anaesthesia and Postoperative Care: Orthopaedic Surgery

  • N. E. Sharrock
Conference paper


Fast-Track can be accomplished by
  • minimizing surgical trauma;

  • reducing perioperative complications by providing a minimal physiological trespass.


Total Knee Arthroplasty Total Knee Replacement Total Joint Arthroplasty Hypotensive Anesthesia Lumbar Epidural Anesthesia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Kreder HJ, Deyo RA, Koepsell T et al (1997) Relationship between the volume of total hip replacements performed by providers and the rates of postoperative complications in the state of Washington [see comments]. J Bone Joint Surg [Am] 79: 485–494Google Scholar
  2. 2.
    Kehlet H (1997) Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth 78: 606–617PubMedCrossRefGoogle Scholar
  3. 3.
    Schmied H, Kurz A, Sessler DI et al (1996) Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 347: 289–292PubMedCrossRefGoogle Scholar
  4. 4.
    Sharrock NE, Salvati EA (1996) Hypotensive epidural anesthesia for total hip arthroplasty. Acta Orthop Scand 67: 91–107PubMedCrossRefGoogle Scholar
  5. 5.
    Sharrock NE, Mineo R, Urquhart B et al (1993) The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty. Anesth Analg 76: 580–584PubMedGoogle Scholar
  6. 6.
    Sharrock NE, Mineo R, Go G (1993) The effect of cardiac output on intraoperative blood loss during total hip arthroplasty. Reg Anesth 18: 24–29PubMedGoogle Scholar
  7. 7.
    Sharrock NE, McCabe JP, Go G et al (1999) Dose response of intravenous heparin on markers of thrombosis during primary total hip replacement. Anesthesiology 90: 981–987PubMedCrossRefGoogle Scholar
  8. 8.
    Thompson GE, Miller RD, Stevens WC et al (1978) Hypotensive anesthesia for total hip arthroplasty: A study of blood loss and organ function (brain, heart, liver, and kidney). Anesthesiology 48: 91–96Google Scholar
  9. 9.
    Modig J, Maripuu E, Sahlstedt B (1986) Thromboembolism following total hip replacement: A prospective investigation of 94 patients with emphasis on the efficacy of lumbar epidural anesthesia in prophylaxis. Reg Anesth 11: 72–79Google Scholar
  10. 10.
    Davis FM, McDermott E, Hickton C et al (1987) Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty. Br J Anaesth 59: 561–571PubMedCrossRefGoogle Scholar
  11. 11.
    Davis FM, Laurenson VG, Gillespie WI et al (1989) Deep vein thrombosis after total hip replacement. J Bone Joint Surg [Br] 71-B: 181–185Google Scholar
  12. 12.
    Warwick D, Harrison J, Glew D et al (1998) Comparison of the use of a foot pump with the use of low-molecular-weight heparin for the prevention of deep-vein thrombosis after total hip replacement. A prospective, randomized trial. J Bone Joint Surg [Am] 80-A: 1158–1166Google Scholar
  13. 13.
    Patterson BM, Marchand R, Ranawat C (1989) Complications of heparin therapy after total joint arthroplasty [see comments]. J Bone Joint Surg [Am] 71: 1130–1134Google Scholar
  14. 14.
    Bierbaum BE, Callaghan JJ, Galante JO et al (1999) An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg [Am] 81-A: 2–10Google Scholar
  15. 15.
    Bickell WH, Wall MJ Jr, Pepe PE et al (1994) Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med 331: 1105–1109PubMedCrossRefGoogle Scholar
  16. 16.
    Fender D, Harper WM, Thompson JR et al (1997) Mortality and fatal pulmonary embolism after primary total hip replacement. Results from a regional hip register [see comments]. J Bone Joint Surg [Br] 79: 896–899Google Scholar
  17. 17.
    Murray DW, Britton AR, Bulstrode CJK (1996) Thromboprophylaxis and death after total hip replacement. J Bone Joint Surg [Br] 78-B: 863–870Google Scholar
  18. 18.
    Eriksson BI, Ekman S, Baur M et al (1997) Regional block anaesthesia versus general anaesthesia. Are different antithrombotic drugs equally effective in patients undergoing hip replacement? Retrospective analysis of 2354 patients undergoing hip replacement receiving either recombinant hirudin, unfractionated heparin or enoxaparin (abstract). Thromb Haemost June[Suppl]: 487 (PS-1992)Google Scholar
  19. 19.
    Westrich GH, Farrell C, Bono JV et al (1999) The incidence of venous thromboembolism after total hip arthroplasty: A specific hypotensive epidural anesthesia protocol. J Arthroplasty 14: 456–463Google Scholar
  20. 20.
    McCabe JP, Sharrock NE, Salvati EA et al (1997) Intraoperative heparin and hypotensive epidural anesthesia in the prevention of thromboembolism following total hip arthroplasty. Orthop Trans 21: 124Google Scholar
  21. 21.
    Sharrock NE, Haas SB, Hargett MJ et al (1991) Effects of epidural anesthesia on the incidence of deep-vein thrombosis after total knee arthroplasty. J Bone Joint Surg [Am] 73-A: 502–506Google Scholar
  22. 22.
    Williams-Russo P, Sharrock NE, Haas SB et al (1996) Randomized trial of epidural versus general anesthesia. Outcomes after primary total knee replacement. Clin Orthop 331: 199–208Google Scholar
  23. 23.
    Westrich GH, Sculco TP (1996) Prophylaxis against deep venous thrombosis after total knee arthroplasty. Pneumatic plantar compression and aspirin compared with aspirin alone. J Bone Joint Surg [Am] 78-A: 826–834Google Scholar
  24. 24.
    Sharrock NE, Go G, Harpel PC et al (1995) Thrombogenesis during total hip replacement. Clin Orthop 319: 16–27PubMedGoogle Scholar
  25. 25.
    Sharrock NE, Go G, Williams-Russo P et al (1997) Comparison of extradural and general anaesthesia on the fibrinolytic response to total knee arthroplasty. Br J Anaesth 79: 29–34PubMedCrossRefGoogle Scholar
  26. 26.
    Bading B, Blank S, Sculco TP et al (1994) Augmentation of calf blood flow by epinephrine infusion during lumbar epidural anesthesia. Anesth Analg 78: 1119–1124PubMedCrossRefGoogle Scholar
  27. 27.
    Lieberman JR, Geerts WH (1994) Prevention of venous thromboembolism after total hip and knee arthroplasty. J Bone Joint Surg [Am] 76-A: 1239–1250Google Scholar
  28. 28.
    Byrick R, Kay J, Mullen J (1987) Pulmonary marrow embolism: a dog model simulating dual component cemented arthroplasty. Can J Anaesth 34: 336–342PubMedCrossRefGoogle Scholar
  29. 29.
    Patterson BM, Healy JH, Cornell CN et al (1991) Cardiac arrest during hip arthroplasty with a cemented long-stem component. J Bone Joint Surg [Am] 73-A: 271–277Google Scholar
  30. 30.
    Berman AT, Parmet JL, Harding SP et al (1998) Emboli observed with use of transesophageal echocardiography immediately after tourniquet release during total knee arthroplasty with cement. J Bone Joint Surg [Am] 80-A: 389–396Google Scholar
  31. 31.
    Sharrock NE, Go G, Milman S et al (1999) The influence of tourniquet application on pulmonary vascular resistance and lung shunt during one-stage bilateral total knee arthroplasty. Acta Anaesthesiol Scand[Suppl]43: 113Google Scholar
  32. 32.
    Abdel-Salam A, Eyres K (1995) Effects of tourniquet during total knee arthroplasty. A prospective randomised study. J Bone Joint Surg [Br] 77-B: 250–253Google Scholar
  33. 33.
    Capdevila X, Barthelet Y, Biboulet P et al (1999) Effects of perioperative analgesic technique on the surgical outcome and duration of rehabilitation after major knee surgery. Anesthesiology 91: 8–15PubMedCrossRefGoogle Scholar
  34. 34.
    Todd MM, Brown DL (1999) Regional anesthesia and postoperative pain management: longterm benefits from a short-term intervention. Anesthesiology 91: 1–2PubMedCrossRefGoogle Scholar
  35. 35.
    Singelyn FJ, Deyaert M, Joris D et al (1998) Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous three-in-one block on postoperative pain and knee rehabilitation after unilateral total knee arthroplasty. Anesth Analg 87: 88–92PubMedGoogle Scholar
  36. 36.
    Williams-Russo P, Sharrock NE, Mattis S et al (1995) Cognitive effects after epidural vs general anesthesia in older adults. A randomized trial. JAMA 274: 44–50Google Scholar
  37. 37.
    Kahn RL, Hargett MJ, Urquhart B et al (1993) Supraventricular tachyarrhythmias during total joint arthroplasty: Incidence and risk. Clin Orthop 296: 265–269Google Scholar
  38. 38.
    Michelson JD, Lotke PA, Steinberg ME (1988) Urinary-bladder management after total joint-replacement surgery. N Engl J Med 319: 321–326PubMedCrossRefGoogle Scholar
  39. 39.
    Williams-Russo P, Sharrock NE, Mattis S et al (1999) Randomized trial of hypotensive epidural anesthesia in older adults. Anesthesiology 91: 926–935PubMedCrossRefGoogle Scholar
  40. 40.
    Sharrock NE, Cazan MG, Hargett MJL et al (1995) Changes in mortality after total hip and knee arthroplasty over a ten-year period. Anesth Analg 80: 242–248PubMedGoogle Scholar
  41. 41.
    Sharrock NE, Mineo R, Urquhart B (1991) Haemodynamic effects and outcome analysis of hypotensive extradural anaesthesia in controlled hypertensive patients undergoing total hip arthroplasty. Br J Anaesth 67: 17–25PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia 2000

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  • N. E. Sharrock

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