**6. Fat embolism**

#### **6.1. Etiology**


#### **6.2. Diagnosis**

With the presence of free fat in sputum and urine and in histological examination, petechiae and hyperlipidemia are diagnosed, with maximum level of free fat being reached in 3–4 days [8].

#### **6.3. Treatment**

Hypovolemia and shock should be treated. Clofibrate (atromid-S) and alcohol should be used for hyperlipidemia.

#### **6.4. Preanesthesia assessment in arthroplasties**

• Personal background.

Slowly entering a small air bubble has usually minimal physiological importance. In this case, venous air bubbles are taken out from lungs based on increased compensator pulmonary artery pressure (PAP). If this situation exceeds the capacity of lung removal, PAP increases, cardiac output (CO) decreases and hearth failure occurs. If balanced, namely, if venous air

300-ml air is fatal in adults. In animal trials, 1 ml/kg/min causes embolism signs; 3–8 ml/kg causes death. The earliest sign is cardiovascular collapse. Blood pressure decreases dramatically; sudden hypotension, tachycardia, arrhythmia and cardiac arrest occur in succession. CVP increases; a metallic sound is heard with the precordial or esophageal stethoscope. In case of this, characteristic "sound of the mill wheel" is heard. This sound can be heard in all precordium. Respiratory changes such as increased respiratory rate, irregularity and apnea

• Other methods: Monitoring should be done for patient in a sitting position. In these pa-

With the presence of free fat in sputum and urine and in histological examination, petechiae and hyperlipidemia are diagnosed, with maximum level of free fat being reached in 3–4 days [8].

Hypovolemia and shock should be treated. Clofibrate (atromid-S) and alcohol should be used

, Doppler

tients, continuous measurement of arterial blood pressure, CVP, end-tidal CO2

ultrasound and esophageal stethoscope should be applied.

input is equal to pulmonary removal, PAP reaches a plateau.

can be seen.

**5.1. Diagnosis**

• End-tidal CO2

**6. Fat embolism**

**6.1. Etiology**

• Bone fractures

**6.2. Diagnosis**

**6.3. Treatment**

for hyperlipidemia.

• Liver and kidney ruptures • Rarely, after bone surgery

• PAP

• Doppler ultrasonic flow meter

54 Total Hip Replacement - An Overview


#### *6.4.1. The evaluation of cardiovascular system*

MET's (classification of metabolic equivalent) meaning is that 40 years old, 70-kg man expresses oxygen consumption at rest. It is considered to be over 4 in the MET evaluation, can go uphill, go up 2 stories of stairs, walk straight on the road at 6 km/h, run short distance, do heavy work at home and participate in moderate activities. Patients with MET ≥4 are considered to be good in terms of functional capacity.


*6.4.2. Cardiovascular risk assessment: the Lee risk index is the most appropriate for orthopedic patients*

Hypoxia may be associated with pulmonary collapse and/or infection. Preoperative physio-

Death, pneumonia, prolonged extubation and persistent bronchospasm can be seen in patients with COPD and smokers. The length of stay in intensive care unit is longer. The incidence of postoperative pulmonary complications is about 25–90% (If FEV1 < 65%, risk of complications

a strong risk factor for preoperative pulmonary complication. In case of preoperative inhaler use, respiratory exacerbations and the presence of lung infection, antibiotic and supportive

In the group of patients planned for arthroplasty, weakening of the memory, decrease in cognitive and intellectual functions, diminished movements, deterioration of sleep order, decrease in visual, acoustical, taste and smell sensation, autonomic nervous system imbalances, Parkinson, depression and dementia are common. If there is a suspicion of a mental condition of the patient, the mental status test (Mini Mental Status Test) can be planned.

There is a risk of renal insufficiency and preoperative azotaemia related to age. Prerenal azotaemia should be corrected by hydration, by taking patients into dialysis program if necessary

Autonomic dysfunction, which is usually caused by diabetes mellitus in a long term, is an important actor for regional anesthesia and for control of perioperative hemodynamic. There is a possibility of silent myocardial ischemia. Oral antidiabetics should be stopped at least

Because patients undergoing arthroplasty are geriatrics, preoperative nutritional status should be evaluated. Their nutritional status is assessed by Mini Nutritional Assessment Test. If albumin is <3.5 gr/dl, the patient should be supported. Reduced glomerular filtration rates due to age should be considered. Urea, serum creatinine and electrolytes should be

is above 45 mmHg, it is

57

Anesthesia Management in Total Hip Replacement http://dx.doi.org/10.5772/intechopen.76366

therapy and spirometer may be beneficial to postoperative hypoxia.

>50%). Arterial blood gas analysis may be done. If the value of PaCO2

treatment should be provided with optimal conditions.

**8. Neurological assessment**

**9. Renal assessment**

**10. Glycaemia control**

24 hours before the operation.

**11. Nutrition control**

examined.

and by optimizing biochemical values.

Number of current risks and incidence of cardiac complications


#### *6.4.3. Cardiovascular drug management*


Antithrombotic agents; fondaparinux, unfractionated heparin (UFH) and low molecular weight heparin (LMWH).

### **7. Airway assessment**

There is a risk of difficult mask ventilation and difficult intubation due to hardness in the neck, dental deterioration and cervical joint degeneration.

Hypoxia may be associated with pulmonary collapse and/or infection. Preoperative physiotherapy and spirometer may be beneficial to postoperative hypoxia.

Death, pneumonia, prolonged extubation and persistent bronchospasm can be seen in patients with COPD and smokers. The length of stay in intensive care unit is longer. The incidence of postoperative pulmonary complications is about 25–90% (If FEV1 < 65%, risk of complications >50%). Arterial blood gas analysis may be done. If the value of PaCO2 is above 45 mmHg, it is a strong risk factor for preoperative pulmonary complication. In case of preoperative inhaler use, respiratory exacerbations and the presence of lung infection, antibiotic and supportive treatment should be provided with optimal conditions.
