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Troponin arthroplasty

Alana E Sigmund, Yixin Fang, Matthew Chin, Harmony R Reynolds, Leora I Horwitz, Ezra Dweck, Eduardo Iturrate
OBJECTIVE: To determine the clinical significance of tachycardia in the postoperative period. PATIENTS AND METHODS: Individuals 18 years or older undergoing hip and knee arthroplasty were included in the study. Two data sets were collected from different time periods: development data set from January 1, 2011, through December 31, 2011, and validation data set from December 1, 2012, through September 1, 2014. We used the development data set to identify the optimal definition of tachycardia with the strongest association with the vascular composite outcome (pulmonary embolism and myocardial necrosis and infarction)...
January 2017: Mayo Clinic Proceedings
M Melanie Lyons, Nitin Y Bhatt, Elizabeth Kneeland-Szanto, Brendan T Keenan, Joanne Pechar, Branden Stearns, Nabil M Elkassabany, Stavros G Memtsoudis, Allan I Pack, Indira Gurubhagavatula
Obstructive sleep apnea (OSA) is highly prevalent in patients undergoing total joint arthroplasty (TJA) and is a major risk factor for postoperative cardiovascular complications and death. Recognizing this, the American Society of Anesthesiologists urges clinicians to implement special considerations in the perioperative care of OSA patients. However, as the volume of patients presenting for TJA increases, resources to implement these recommendations are limited. This necessitates mechanisms to efficiently risk stratify patients having OSA who may be susceptible to post-TJA cardiovascular complications...
2016: Biomarkers in Medicine
Anne Ruth Bass, Tomás Rodriguez, Gina Hyun, Francisco Gerardo Santiago, Jacqueline Ilji Kim, Scott Christopher Woller, Brian Foster Gage
PURPOSE: Because the occurrence of postoperative myocardial ischaemia (MI) predicts subsequent cardiac morbidity and mortality, we determined the prevalence of and risk factors for MI in hip and knee arthroplasty patients. METHODS: High-sensitivity cardiac troponin T (hs-cTnT) was measured on stored samples from postoperative day two in 394 hip and knee arthroplasty patients ≥ 65 years of age enrolled in the Genetics-InFormatics Trial (GIFT). RESULTS: Fifty-three (13...
October 2015: International Orthopaedics
Lili Xu, Zhiyong Hu, Jianjun Shen, Patrick M McQuillan
This study was designed to determine the effects of dexmedetomidine on perioperative myocardial injury by observing peripheral circulatory changes in response to tracheal intubation and extubation, myocardial enzyme levels, myocardial ischaemia improvements, cardiovascular adverse events and cytokines in patients with coronary heart disease (CHD) undergoing non-cardiac surgery. This study was a prospective, randomized, double-blind trial. Eighty patients having CHD were scheduled for elective hip-replacement surgery and randomly allocated to receive a loading dose of 1 μg/kg dexmedetomidine followed by a 0...
November 2014: Clinical and Experimental Pharmacology & Physiology
J Jerosch, S Stobbe, G Schmid, J Schunck, T Filler
PURPOSE: The purpose of the present study was to evaluate the MRI of the hip musculature as well as specific blood parameters on comparison of the Bauer approach with the minimally invasive ALMI approach. MATERIAL AND METHODS: We compared two patient groups after total hip replacement, which were operated either via the Bauer or the ALMI approach. All 47 patients had the same cementless hip design. All surgeries were performed by two experienced hip surgeons with experience of more than 1200 ALMI approaches...
December 2012: Zeitschrift Für Orthopädie und Unfallchirurgie
Kenneth F Ryan, James W Price, C Brian Warriner, Peter T Choi
PURPOSE: To describe a case of persistent hypothermia following spinal anesthesia with intrathecal morphine. CLINICAL FEATURES: Following elective right total knee arthroplasty under spinal anesthesia with isobaric 0.5% bupivacaine 11 mg, fentanyl 15 μg, and preservative-free morphine 150 μg, a 57-yr-old female (93.5 kg, 151 cm) developed postoperative hypothermia with a nadir rectal temperature of 33.6°C four hours after surgery. At times, her temperature could not be measured by tympanic, temporal arterial, oral, axillary, or rectal routes...
April 2012: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Spencer S Liu, James J Bae, Mihai Bieltz, Yan Ma, Stavros Memtsoudis
BACKGROUND AND OBJECTIVES: Use of nonsteroidal anti-inflammatory drug (NSAIDs) analgesics is controversial because of cardiovascular risk, but perioperative use may be advantageous for total joint replacement. Thus, we performed this single-center observational cohort study to determine any association between NSAID use and postoperative myocardial infarction (POMI). METHODS: All patient admissions undergoing total hip or knee replacement between March 3, 2009, and September 1, 2010, were identified...
January 2012: Regional Anesthesia and Pain Medicine
Christina I Olofsson, Andrzej Z Górecki, Ris Dirksen, Ivo Kofranek, Jacek A Majewski, Tomasz Mazurkiewicz, David Jahoda, Bengt Fagrell, Peter E Keipert, Yun J Hardiman, Howard Levy
BACKGROUND: MP4OX (oxygenated polyethylene glycol-modified hemoglobin) is an oxygen therapeutic agent with potential applications in clinical settings where targeted delivery of oxygen to ischemic tissues is required. The primary goal of this study was to investigate MP4OX for preventing hypotensive episodes. An additional goal was to establish the safety profile of MP4OX in a large surgical population. METHODS: Patients (n = 367) from 18 active study sites in six countries, undergoing elective primary hip arthroplasty with spinal anesthesia, were randomized to receive MP4OX or hydroxyethyl starch 130/0...
May 2011: Anesthesiology
Philippe van der Linden, Tadeusz S Gazdzik, David Jahoda, René J Heylen, Jan C Skowronski, David Pellar, Ivo Kofranek, Andrzej Z Górecki, Bengt Fagrell, Peter E Keipert, Yun J Hardiman, Howard Levy et al.
BACKGROUND: MP4OX (oxygenated polyethylene glycol-modified hemoglobin) is a novel oxygen therapeutic agent specifically developed to perfuse and oxygenate tissue at risk for ischemia and hypoxia. In this study, we investigated the ability of MP4OX to treat hypotensive episodes. In addition, the tolerability profile of MP4OX in a large surgical population was established. METHODS: Patients from 21 study sites in 5 countries, scheduled to undergo primary hip arthroplasty under spinal anesthesia, were randomized in a double-blind manner to receive MP4OX or hydroxyethyl starch (HES) solution (Voluven®; HES 130/0...
April 2011: Anesthesia and Analgesia
Doerte Matziolis, Georgi Wassilew, Patrick Strube, Georg Matziolis, Carsten Perka
INTRODUCTION: In Europe the minimized transgluteal (TG) and anterolateral (AL) approaches are increasingly preferred in hip arthroplasty (THA). METHOD: The present investigation determined which of these approaches causes the least muscle trauma. Forty patients who received a THA were enrolled in this prospective randomized study. Muscle trauma was quantified by perioperatively measuring the serum concentration of skeletal troponin I (sTnI). The Harris hip score (HHS) was determined before and 12 months after surgery...
May 2011: Archives of Orthopaedic and Trauma Surgery
J Y Lee, C J Kim, M Y Chung
This study investigated the effects of high-dose vitamin C on oxygen free radical production and cardiac enzymes after tourniquet application and ischaemia-reperfusion injury during bilateral total knee replacement (TKR) in elderly patients. In the vitamin C (VC) group (VC group, n = 16), during surgery, patients received a priming bolus of 0.06 g/kg vitamin C with 100 ml saline followed by 0.02 g/kg vitamin C mixed with 30 ml saline, intravenously. The control group (n = 16) received no intra-operative vitamin C...
July 2010: Journal of International Medical Research
Michael J Ray, Lorenzo J Calabro, Tilak Sirisena, Scott A Crawford, Ross W Crawford, Darren L Walters
BACKGROUND: Peri-operative cardiac events are common and associated with significant morbidity. A predictive biomarker would assist in pre-operative risk stratification of surgical patients. This study explored the utility of pre-operative measurements of platelet-bound CD40 ligand and other biomarkers for predicting peri-operative cardiac events in total hip or knee arthroplasty. METHODS: Blood samples were collected from 62 patients prior to surgery and tested for the biomarkers platelet CD40 ligand, platelet factor V/Va, platelet P-selectin, high-sensitivity C-reactive protein, B-type natriuretic peptide and soluble CD40 ligand...
June 2010: European Journal of Clinical Investigation
Wilton A van Klei, Gregory L Bryson, Homer Yang, Alan J Forster
BACKGROUND: American College of Cardiology/American Heart Association guidelines recommend beta-blockade for selected low- and intermediate-risk noncardiac surgery patients. The authors evaluated the effect of perioperative beta-blockade on postoperative myocardial infarction (POMI) in low-risk patients undergoing intermediate-risk surgery. METHODS: Patients who underwent elective hip or knee arthroplasty between January 1, 2002 and June 30, 2006 were identified...
October 2009: Anesthesiology
Russell G Cohen, Jay A Katz, Nebojsa V Skrepnik
Various reports confirm elevations in serum markers associated with skeletal muscle injury after orthopaedic surgery in the absence of overt clinical manifestations of myocardial injury. We therefore measured the influence surgical approach has on these serum markers after primary THA. We nonrandomly enrolled 30 nonconsecutive patients undergoing THA in three groups of 10 based on current surgical approaches used at our facility: (1) minimally invasive (MIS) modified Watson Jones approach; (2) miniposterior transmuscular approach (MIS-I); and (3) MIS-II incision...
July 2009: Clinical Orthopaedics and related Research
M K Urban, K Jules-Elysee, C Loughlin, W Kelsey, E Flynn
The diagnosis of a postoperative myocardial infarction (PMI) is important in the orthopedic population because these events can be associated with significant cardiac morbidity. Plasma troponin I (cTnI) analysis has markedly increased our ability to detect myocardial damage. Using cTnI analysis for evidence of a PMI, we prospectively assessed all of our patients for (1) the 1-year incidence of PMI, (2) the clinical consequences of a PMI in relation to the level of the cTnI release, and (3) 6-month follow-up for cardiac complications...
February 2008: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
George Mouzopoulos, Christos Kouvaris, Dimitrios Antonopoulos, Mihalis Stamatakos, Anastasia Tsembeli, George Mouratis, Mathaios Tzurbakis, Mihalis Safioleas
BACKGROUND: Perioperative myocardial infarction (MI) is an important risk factor for cardiac morbidity and mortality after hip surgery. On the basis of the limitations of creatine kinase cardiac muscle isoenzyme (CK-MB) in the perioperative setting, and the high specificity of troponin I, we hypothesized that troponin I would be effective at detecting perioperative MI more frequently than CK-MB would be, after hip surgery. METHODS: A prospective study of the serum levels of creatine phosphokinase (CPK), its isoenzyme CK-MB, and troponin I, in 90 patients with risk factors for coronary artery disease, undergoing hip surgery is reported...
August 2007: Journal of Trauma
Martina Montagnana, Giuseppe Lippi, Dario Regis, Cristiano Fava, Gino Viola, Pietro Bartolozzi, Gian Cesare Guidi
BACKGROUND: Cardiovascular morbidity is frequent after non-cardiac surgery and the early recognition of cardiac involvement is an essential tool for clinical risk stratification and management. The aim of this study was to investigate the behavior of traditional and emerging cardiac markers, including NT-prohormone-brain natriuretic peptide (NT-proBNP) and ischemia-modified albumin (IMA), in the perioperative period in patients undergoing major uncomplicated orthopedic surgery. METHODS: A total of 37 patients undergoing major orthopedic surgery were longitudinally evaluated for NT-proBNP, IMA, cardiac troponin T (cTnT), creatine kinase isoenzyme MB and myoglobin 3 h before surgery and 4 and 72 h thereafter...
2006: Clinical Chemistry and Laboratory Medicine: CCLM
C Karcher, H-J Dieterich, T H Schroeder
We report the case of a morbidly obese patient who developed rhabdomyolysis with acute renal failure, hepatic dysfunction, and an increase of cardiac troponin-1 after total knee arthroplasty. Postoperative rhabdomyolysis has a wide range of triggers and differential diagnoses that should be considered by the anaesthesiologist and surgeons. We would like to emphasize that morbidly obese patients have an increased risk of developing postoperative rhabdomyolysis potentially leading to life-threatening disease...
December 2006: British Journal of Anaesthesia
H Higham, J W Sear, Y M Sear, M Kemp, R J L Hooper, P Foex
We have previously demonstrated that the peri-operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase-MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients undergoing major vascular surgery or major joint arthroplasty to 1 year using a patient questionnaire, general practitioner follow-up and case-notes review. Increased postoperative marker concentrations were defined as values greater than the upper reference limit...
April 2004: Anaesthesia
K Jules-Elysee, M K Urban, B Urquhart, S Milman
STUDY OBJECTIVE: To assess the utility of troponin I, the only molecular marker of myocardial injury not expressed in regenerating muscle, in diagnosing perioperative myocardial infarction (MI) in the setting of orthopedic surgery where false elevations in creatine kinase MB isoenzymes (CKMB) are known to occur. DESIGN: Prospective study. SETTING: University-affiliated hospital. PATIENTS: 85 patients with risk factors for coronary artery disease (CAD) who were scheduled for orthopedic surgery, including total knee arthroplasty, 34; total hip arthroplasty, 36; posterior spine fusion, 7; and other orthopedic operations, 8...
December 2001: Journal of Clinical Anesthesia
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