Anesthesia Student Survival Guide.pdf - Index of

AnesthesiA For trAuMA And orthoPediC surGery ● 407
cause direct vasodilation with resultant hypotension and tachycardia. Fluids,
vasopressors, and light anesthesia can help lessen these effects.
Fat embolism syndrome
Patients with long bone fractures are at risk of suffering from this syndrome,
characterized by truncal petechiae, dyspnea/hypoxemia, and mental status
changes. Symptoms typically present within 3 days of injury, and are thought
to be due to fatty globules released into the circulation due to bony disruption.
Treatment involves bone and joint immobilization to avoid further release and
supportive care. The pulmonary and neurologic manifestations of this syndrome
can complicate perioperative management, and fat embolism syndrome is associated
with a significant increase in patient mortality.
Blood loss
As with trauma patients, elective or urgent orthopedic repairs can be associated
with significant amounts of blood loss and coagulopathy. A large amount
of blood can be lost into the soft tissues of the thigh or upper arm, making
estimates of blood loss difficult. Cell salvage techniques have been used successfully
during joint replacement, although care must be taken to avoid its use
if the wound is infected or if cement use is imminent.
Figure 25.3 Hip fracture locations.