Chapter 61
- Anesthesia for Orthopedic Surgery
- Nigel E. Sharrock
- James D. Beckman
- Eileen Connolly Inda
- John J. Savarese
Perhaps no other subspecialty of anesthesia requires facility
with a greater variety of anesthetic techniques than orthopedic anesthesia. As an
alternative to general anesthesia, many procedures may be better managed in orthopedic
patients with regional techniques or with combined regional and general anesthetic
techniques (see Chapter 43
,
Chapter 44
, and Chapter
45
).
In addition to requiring familiarity with an array of regional
anesthetic procedures, orthopedic anesthesia is demanding, requiring a high degree
of skill and a facility with other anesthetic techniques such as bronchoscopic intubation
for complex airway problems (see Chapter
42
), hypotensive anesthesia, hemodilution, intraoperative cell-saver techniques
for minimizing intraoperative blood loss (see Chapter
48
), invasive hemodynamic (see Chapter
32
and Chapter 33
)
and evoked potential monitoring (see Chapter
38
). Although many of the procedures are short, others are long, necessitating
attention to body positioning (see Chapter
28
), maintenance of normothermia, fluid balance, and preservation of peripheral
blood flow, especially in reimplantation procedures. Factors causing perioperative
morbidity and mortality in orthopedics may be different from those of other surgical
specialties and may demand a different focus of attention.
