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At least 37 records · Page 2Linked to original sources
PubMed1998

[Dose-response relationship of clonidine with epidural administration of ropivacaine in orthopedic procedures of the lower extremities].

OBJECTIVE: The aim of this study was to investigate preliminarydose-range effects of clonidine added to ropivacaine for epidural analgesia in elective orthopedic surgery of the lower limbs with doses, causing a minimum of cardiovascular side effects. METHODS: 60 patients were randomly assigned to receive in a double-blind fashion a mixture of 1 mg/cm height ropivacaine plus saline or 1 mg/cm ropivacaine plus 25 micrograms, 50 micrograms, 75 micrograms, 100 micrograms or 150 micrograms clonidine for epidural analgesia. The sensory and motor function were determined at defined time intervals for 30 minutes. Heart rate and blood pressure were controlled and sedation score was judged. The postoperative 2-segment-regression of pin-prick and the onset of pain were recorded. RESULTS: The six groups were comparable in demographic data and in term of onset time. The prolongation of analgesia reached 513 +/- 92 min (p = 0.002) for 150 micrograms clonidine, 460 +/- 148 min (p = 0.073) for 100 micrograms clonidine, 440 +/- 86 min (p = 0.057) for 75 micrograms clonidine compared with 347 +/- 114 min for saline. In an equal manner, 2-segment-regression for pin-prick was extended to 251 +/- 47 min (p = 0.018) for 150 micrograms clonidine, 238 +/- 33 min (p = 0.034) for 100 micrograms clonidine, 229 +/- 29 min (p = 0.027) for 75 micrograms clonidine and 178 +/- 43 min for saline. Heart rate dropped down in all groups. Mean arterial pressure decreased significantly in the groups with 75, 100 and 150 micrograms clonidine. Sedation score increased continuously from 0.6 +/- 0.5 (saline) to 1.8 +/- 0.8 (150 micrograms clonidine). CONCLUSION: We conclude that 150 micrograms clonidine significantly enhances the duration of analgesia of epidurally administered ropivacaine in a mean of 171 mg. This time interval is longer than the one with 200 mg ropivacaine alone. But, there are side effects in form of decrease of arterial pressure. Cardiovascular monitoring seems to be essential. Because of the enhanced analgesia duration, the time interval for reloading epidural anaesthesia are increased.

Adrenergic alpha-Agonists↗
PubMedDate not supplied

Orthopedic procedures after rhizotomy.

The goal of selective dorsal rhizotomy (SDR) is to reduce surgically abnormal excitatory impulses to the lower extremities and thus to decrease spasticity in patients with cerebral palsy. One hundred thirty-one patients underwent SDR from 1986 to 1994 and were retrospectively reviewed for changes in tone, requirements for orthopedic intervention, and changes in ambulatory status. One hundred twelve patients had adequate follow-up. Postrhizotomy tone was decreased in all of the 112 patients, as measured by the Ashworth scale. No statistically significant change in ambulatory status was found. A total of 71 (65%) of 112 patients required orthopedic intervention for continued contractures and deformity. Of those judged "hypotonic" by the physiatrist postoperatively, 37% required subtalar stabilization for severe planovalgus. Hip subluxation was noted and treated (by femoral or pelvic osteotomy or both) in 27 (25%) of 112. Despite appropriately completed SDR, parents must understand the importance of periodic long-term follow-up and the possible, if not likely, need for additional surgery to alleviate contractures and stabilize subluxation of joints.

Adolescent↗
PubMed2006

The analgesic efficacy of acetaminophen, ketoprofen, or their combination for pediatric surgical patients having soft tissue or orthopedic procedures.

The combined use of acetaminophen and a nonsteroidal antiinflammatory drug has been shown to provide better postoperative analgesia than either drug alone in several adult studies. However, there are no pediatric studies analyzing similar effects when the currently recommended doses of acetaminophen are used. In a double-blind, placebo-controlled design we randomized 120 children, aged 1-9 yr, undergoing orthopedic or soft tissue surgery, into 3 groups to receive either acetaminophen 60 mg/kg rectally and 40 mg/kg orally, ketoprofen 2 mg/kg IV twice, or the combination of the active drugs. The first drug doses were given at anesthetic induction and the second doses 8 h thereafter. During anesthesia all children received sevoflurane and a continuous infusion of remifentanil. Postoperative pain was evaluated by the behavioral objective pain scale (0-9) for 24 h. The rescue medication was morphine 0.05 mg/kg IV. The primary outcome variable was morphine consumption. For statistical analysis, analysis of variance, chi2 test and Kaplan-Meier survival analysis were used. Morphine requirement was less in the combination than in the acetaminophen group both in the postanesthesia care unit (2.5 +/- 1.7 versus 3.9 +/- 2.1 morphine doses) and during the 24-h postoperative follow-up (4.1 +/- 2.5 versus 5.9 +/- 2.9 morphine doses) (P < 0.05). No differences existed between the ketoprofen and the acetaminophen groups. The objective pain scale scores were lowest in the combination group both in the postanesthesia care unit and in the postoperative ward (P < 0.05). When children were divided based on their surgery, opioid requirement and pain scores were less in the combination than in the parent drug groups only after orthopedic surgery. The combination of acetaminophen 100 mg/kg and ketoprofen 4 mg/kg in a day provided better analgesia and lower pain scores after orthopedic, but not soft tissue, surgery in children.

Acetaminophen↗
PubMed1999

[Intraoperative normothermia with partial warming of patients undergoing orthopedic procedures].

OBJECTIVE: This study investigates if warming of the upper or lower half of the body preserves normothermia in patients undergoing major orthopaedic surgery. Additionally, we compared the intraoperative tympanic membrane and urinary bladder temperatures of these patients. METHODS: Fifty-four patients undergoing major orthopaedic operations were observed. In all patients general anaesthesia was induced with fentanyl, etomidate, and atracurium and was maintained with isoflurane and nitrous oxide. Thirty patients were randomly allocated to maintain normal body temperatures (WarmTouch 5000. Mallinckrodt Medical, level IV, 41-42 degrees C), whereas 24 patients were not actively warmed. Warming of the patients was performed by complete body heating preoperatively and warming of the upper (n = 19) or lower (= 11) half of the body intraoperatively. Core temperature was recorded from the tympanic membrane. The urinary bladder temperature was measured by a special urinary catheter. RESULTS: Without active warming of the patients the core temperature decreased 1.6 degrees C during surgery. Core temperature remained constant in all actively heated patients, regardless of upper or lower body heating. Hypothermia of the unwarmed patients was detected by both, tympanic membrane measurement and--with a short delay--the urinary bladder temperature probe. CONCLUSION: This data suggests that active warming of the upper or lower half of the body during major orthopaedic surgery can preserve normothermia in all patients. During these surgical procedures the urinary bladder temperature was able to represent reliable core temperatures.

Anesthesia, General↗
PubMed2001

Urinary infection after orthopedic procedures.

We have investigated prospectively the incidence of urinary tract infection (UTI) in 5320 orthopaedic patients. There were 74 UTIs (1.39%). Enterobacteriaceae was the most frequent etiological agent. Each infection increased the length of stay in hospital by more than 8 days. Statistically independent risk factors for the development of urinary infection were a preoperative stay of more than 4 days, inadequate preoperative preventive measures, central venous catheterization and urinary catheterization. Sex, age, or type of surgery had no statistical influence on the development of infection.

Adolescent↗
PubMed2006

Improvement of gentamicin poly(D,L-lactic-co-glycolic acid) microspheres for treatment of osteomyelitis induced by orthopedic procedures.

Poly(D,L-lactide-co-glycolide) (PLGA) biodegradable microspheres with gentamicin for local treatment of microbial bone infection were prepared and characterized. Gentamicin was assayed spectrophotometrically at 332 nm after derivation with the o-phthalaldehyde; biodegradable polymers studied did not interfere with this method of gentamicin analysis. PLGA microspheres were made by the double emulsion solvent evaporation method with modifications. The first W(1)/O emulsion was obtained by ultrasonication or high-speed homogenization, and a large aqueous phase W(2) (200 ml) was used. The ultrasonication method increases the microsphere percentage observed in the 20-40 microm size range and, in all cases SEM-microphotographs revealed homogeneous and spherically shaped particles with smooth surfaces. The method including ultrasonication proposed in the present work improved the encapsulation efficiency of gentamicin by nearly 100% (97.94%). Several mathematical models based on heterogeneous hydrolytic degradation were applied to evaluate their suitability in describing gentamicin released from PLGA microspheres. Two models, one of them including an autocatalytic process, were finally proposed to contribute to understand the mass transport mechanism involved in drug release from these microspheres.

Antineoplastic Agents↗
PubMed2006

Analysis of patient flows for orthopedic procedures using small area analysis in Switzerland.

BACKGROUND: In general cantons regulate and control the Swiss health service system; patient flows within and between cantons are thereby partially disregarded. This paper develops an alternative spatial model, based upon the construction of orthopedic hospital service areas (HSAOs), and introduces indices for the analysis of patient streams in order to identify areas, irrespective of canton, with diverse characteristics, importance, needs, or demands. METHODS: HSAOs were constructed using orthopedic discharge data. Patient streams between the HSAOs were analysed by calculating three indices: the localization index (% local residents discharged locally), the netindex (the ratio of discharges of nonlocal incoming residents to outgoing local residents), and the market share index (% of local resident discharges of all discharges in local hospitals). RESULTS: The 85 orthopedic HSAOs show a median localization index of 60.8%, a market share index of 75.1%, and 30% of HSAOs have a positive netindex. Insurance class of bed, admission type, and patient age are partially but significantly associated with those indicators. A trend to more centrally provided health services can be observed not only in large urban HSAOs such as Geneva, Bern, Basel, and Zurich, but also in HSAOs in mountain sport areas such as Sion, Davos, or St.Moritz. Furthermore, elderly and emergency patients are more frequently treated locally than younger people or those having elective procedures. CONCLUSION: The division of Switzerland into HSAOs provides an alternative spatial model for analysing and describing patient streams for health service utilization. Because this small area model allows more in-depth analysis of patient streams both within and between cantons, it may improve support and planning of resource allocation of in-patient care in the Swiss healthcare system.

Adolescent↗
PubMed1977

[Post-operative surveillance and intensive care after orthopedic procedures of the vertebral column (author's transl)].

113 corrective procedures of the vertebral column by ventral and/or dorsal approach have been analysed. The post-operative findings have been reported, including blood-gas analysis, hemoglobin and hematocrit, electrolytes, and fluid balance. A correlative-statistical analysis of the scoliosis group was carried out according to number of involved segments, degree of curvature, age, length of operative time and total blood loss. The post-operative complications were related to preexisting risk factors.

Adolescent↗
PubMed2006

Impact of changes in Medicare Home Health care reimbursement on month-to-month Home Health utilization between 1996 and 2001 for a national sample of patients undergoing orthopedic procedures.

BACKGROUND: Beginning October 1, 1997, Medicare implemented a series of major changes to the Home Health (HH) reimbursement system. Reimbursements were first significantly reduced under the Interim Payment System (IPS) and then relaxed slightly until implementation of the HH Prospective Payment System (PPS) on October 1, 2000. OBJECTIVE: The objective of this study was to examine the impact of reimbursement policy on HH care utilization. RESEARCH DESIGN: We postulated that in response to the initial changes, there would be reductions in both the probability of any HH use and the number of HH visits per HH user. Under PPS, we postulated there would be further reduction in number of HH visits. We tested whether the policy response differed by HH agency structure and whether subgroups of patients were differentially affected. An interrupted time-series analysis was conducted to examine month-to-month probability of HH selection and the number of HH visits among users. SUBJECTS: A 100% sample of all Medicare recipients undergoing either elective joint replacement (1.6 million hospital discharges) or surgical management of hip fracture (1.2 million hospital discharges) between January 1996 and December 2001 was selected. RESULTS: Under the IPS, the probability of any HH use and number of visits per episode of HH care fell until the IPS was refined in October 1998. With implementation of the PPS, HH visits fell commensurately. Differentially larger reductions in care were noted at for-profit HH agencies, for the elderly, women, patients receiving state assistance, and patients first discharged to skilled nursing facility or rehabilitation hospitals. CONCLUSIONS: Changes in month-to-month utilization of HH services were sharp and well correlated with policy implementation dates, strengthening the evidence for a causal association between policy and patient care in the midst of a sea of concurrent policy changes. Greater reductions in HH visits were noted for vulnerable groups.

Aged↗