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Biomedical subjects

C Ranawat

Publications and source records attributed to C Ranawat.

10 recordsLinked to original sources
PubMed1999

Randomized trial of hypotensive epidural anesthesia in older adults.

BACKGROUND: Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients. METHODS: This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective primary total hip replacement with epidural anesthesia. The patients were randomly assigned to one of two levels of intraoperative mean arterial blood pressure management: either to a markedly hypotensive mean arterial blood pressure range of 45-55 mmHg or to a less hypotensive range of 55-70 mmHg. Cognitive outcome was assessed by within-patient change on 10 neuropsychologic tests assessing memory, psychomotor, and language skills from before surgery to 1 week and 4 months after surgery. Prospective standardized surveillance was performed for cardiovascular and renal outcomes, delirium, thromboembolism, and blood loss and replacement. RESULTS: The two groups were similar at baseline in terms of age (mean, 72 yr), sex (50% women), comorbid conditions, and cognitive function. After operation, no significant differences in the incidence of early or long-term cognitive dysfunction were observed between the two blood pressure management groups. There were no significant differences in the rates of other adverse consequences, including cardiac, renal, and thromboembolic complications. In addition, no differences occurred in the duration of surgery, intraoperative estimated blood loss, or transfusion rates. CONCLUSIONS: Elderly patients can safely receive controlled hypotensive epidural anesthesia with this protocol. There was no evidence of greater risks, or early benefits, with the use of the more markedly hypotensive range.

Aged↗
PubMed1995

Comparison of polyethylene wear in machined versus molded polyethylene.

Polyethylene wear debris has been identified as a cause of osteolysis, granuloma formation, and loosening in total hip arthroplasty. This study was designed to evaluate differences in polyethylene wear rates between acetabular cups machined from extruded bar stock and those direct compression molded. Two hundred thirty-six hip prostheses underwent radiographic evaluation using the technique of Livermore et al. Seventy-four were all-polyethylene cups machined from extruded bar stock, and 162 were all-polyethylene cups direct compression molded. Both groups were similar in that the acetabular and femoral components were all cemented, the acetabular components were all polyethylene, nonmetal backed, and bearing surfaces of both groups were polished, cobalt chrome. The femoral components were TRIAD in the machined group and TR28 in the molded group. Patient matching was performed, assigning 54 patients in each group, whose average age was 66 years old, average followup 6.7 years, and average weight 161 pounds. Rates of polyethylene wear then were compared. Results showed a linear wear rate of 0.05 mm per year for compression-molded polyethylene and 0.11 mm per year for machined polyethylene. Results of this study raise questions regarding the types of polyethylene fabrication and its ultimate molecular weight, and wear resistance.

Acetabulum↗
PubMed1993

Factors affecting deep vein thrombosis rate following total knee arthroplasty under epidural anesthesia.

A retrospective review was performed of 448 consecutive patients undergoing primary, unilateral, bicondylar, and cemented total knee arthroplasty under epidural anesthesia by three surgeons to determine factors contributing to deep vein thrombosis rate. All had venography on the fourth or fifth postoperative day and received aspirin and elastic stockings as their only thromboprophylaxis. The overall deep vein thrombosis rate was 41% (2% had proximal clots). The rate of deep vein thrombosis was not related to obesity, history of heart disease, hypertension, prior malignancy, smoking, diagnosis of osteoarthritis, duration of surgery, type of local anesthetic used, or the use of postoperative epidural analgesia. The rate of deep vein thrombosis varied significantly between surgeons: one surgeon had an overall deep vein thrombosis rate of 58% (proximal thrombi, 4%) whereas the other two surgeons had a deep vein thrombosis rate of 35% (proximal clot thrombi, 1%). A number of possible mechanisms to explain the variation in deep vein thrombosis rates between surgeons are provided.

Aged↗
PubMed1993

Triple arthrodesis in rheumatoid arthritis.

Fifty-five patients with rheumatoid arthritis were treated with 65 triple arthrodeses of the hindfoot from March 1975 through July 1985. Twelve patients (12 procedures) have died, and follow-up evaluation could not be completed on three patients (four procedures), leaving 40 patients (49 procedures) available for clinical and roentgenographic evaluation. There were 32 women and eight men, with an average age at the time of surgery of 50 years. The follow-up period averaged five years. Standard operative technique involved medial and lateral incisions with staple fixation and local bone grafting. Correction of deformity was performed with closing wedge osteotomies. All patients had moderate to severe pain preoperatively and difficulty with ambulation. Postoperatively, 94% of the patients had significant pain relief and 83% had complete pain relief. Ambulatory status was improved in 80% of the patients. Ninety percent were at least community ambulators at the time of review, whereas more than half the patients were limited to household ambulation preoperatively. Complications included four superficial wound infections, all of which responded to local care. One patient required revision surgery for pseudarthrosis, and three patients had progression of ankle disease and required pantalar arthrodeses. There was no significant progression of fore-foot or knee symptoms, however, and there was no progression of ankle symptoms in patients whose hindfeet were corrected to 0 degrees-10 degrees valgus. Triple arthrodesis in the rheumatoid population has a high union rate. Pain relief and ambulation improvement can be expected.

Adolescent↗
PubMed1989

Complications of heparin therapy after total joint arthroplasty.

The cases of 112 patients who were treated intravenously with heparin for thromboembolic disease after total joint arthroplasty were reviewed. The over-all frequency of bleeding complications that were associated with therapy with heparin was approximately 30 per cent. In patients who were treated within six days after total joint replacement, the frequency of bleeding complications was 45 per cent. The prevalence of bleeding problems declined to 15 per cent in patients who were treated more than one week after arthroplasty. In roughly 35 per cent of the patients, therapy with heparin had to be discontinued because of complications. Thrombocytopenia developed in fewer than 5 per cent of the patients. It was concluded that anticoagulation therapy with heparin for clinically unimportant thromboembolic problems in the immediate postoperative period is not justified.

Female↗
PubMed1975

The use of spinal anesthesia for total hip-replacement arthroplasty.

Two hundred and thirty-four total hip replacements in 199 patients performed by one surgeon were reviewed to compare the effects of spinal and general anesthesia. The amount of total blood loss was reduced an average of 600 milliliters in patients under spinal anesthesia. The amounts of operative blood loss, postoperative suction drainage, and blood replacement were also reduced very significantly (p smaller than 0.001). The patients in the two anesthesia groups were similar as to sex, age, body weight, pre-existing medical disease, preoperative medications administered, hip disease, type of prosthesis used, position during surgery, and anticoagulation regimen. The postoperative complications were fewer in the spinal anesthesia group. It is concluded from this study that spinal anesthesia is to be preferred over general anesthesia in patients undergoing total hip replacement.

Aged↗