Intraoperative unfractionated heparin before femoral component cementation should be avoided in femoral neck fracture treated with hybrid total hip arthroplasty.

PURPOSE: To compare the incidence of perioperative thromboembolic events in femoral neck fracture (FNF) patients treated with hybrid total hip arthroplasty (THA) with intraoperative unfractionated heparin (UFH) versus a control group without intraoperative UFH before femoral component cementation. METHODS: We compared 139 cases without UFH (group A) versus 134 who received 10 UI/kg UFH (group B). Indication of UFH before cementation depended on the preferences of the anaesthesiologists in each case. We assessed intraoperative bone cement implantation syndrome (BCIS) and 30-day thromboembolic events, and 90-day and 1-year mortality. BCIS was classified as per Donaldson et al.'s classification according to the degree of hypotension, arterial desaturation or loss of consciousness. RESULTS: BCIS was observed in 51 (18%) cases, including 37 (13%) grade 1 and 14 (5%) grade 2. Forty-seven BCISs (35%) were observed in group B and 4 (3%) in group A (p < 0.001). Multivariate regression showed that intraoperative UFH (OR = 18, CI 95% 6-52) and consumption of oral anticoagulants (OR = 3.3, CI 95% 1-10) increased the risk of BCIS. Five patients further developed a 30-day pulmonary embolism in group B, while 2 presented this complication in group A (p = 0.231). No association between BCIS and 30-day thromboembolic events was found (p = 0.62). 90-day (1% each, p = 0.98) and 1-year (2% vs. 3%, p = 0.38) mortality were similar. CONCLUSIONS: BCIS was a frequent finding in FNF patients treated with hybrid THA. We found a paradoxically significant increase in BCIS with the use of UFH. Heparin did not seem to prevent BCIS, other thromboembolic events and mortality in this group of patients.

Whole-Lung Lavage-a Narrative Review of Anesthetic Management.

Pulmonary alveolar proteinosis is a rare disease characterized by progressive accumulation of lipoprotein material in the alveoli as a result of a dysfunction in surfactant clearance. The whole-lung lavage procedure is considered the current standard of care and consists of the sequential lavage of both lungs for mechanical removal of residual material in the alveoli. However, a lack of standardization has resulted in different procedural techniques among institutions. Even though whole-lung lavage is considered to be a safe procedure, unforeseen complications might occur, and proper knowledge of physiologic implications may allow clinicians to establish the appropriate therapy. This review provides an insight into the underlying physiology of the disease, the technical details of the procedure from an anesthesiologist's perspective, and discussion of potential intraoperative complications.

Rotura traumática simultánea y bilateral del tendón del cuádriceps en un paciente fisicoculturista: informe de caso y revisión de la literatura / Simultaneous bilateral traumatic quadriceps tendon rupture in a bodybuilding patient: case report and literature review

La rotura traumática, simultánea y bilateral del tendón cuadricipital es una lesión infrecuente, generalmente asociada a otras enfermedades sistémicas tales como insuficiencia renal o trastornos endocrinos. Presentamos el caso de un varón sano y atleta de 38 años que sufrió esta lesión mientras realizaba una sentadilla en el gimnasio. (AU)

The traumatic bilateral and simultaneous quadriceps tendon rupture is a rare injury, usually associated with other systemic diseases such as renal insufficiency or endocrine disorders. We present the case of a 38-year-old healthy male athlete who sustained this injury while performing a squat at the gym. (AU)

Toxicidad sistémica por anestésicos locales en paciente con hipoalbuminemia severa. Reporte de un caso / Case report Local anesthetic toxicity due to hypoalbuminemia

Local anesthetics are drugs widely used to perform peripheral nerve blocks. Signs and symptoms of toxicity may vary from mild to severe, including neuro and cardiotoxicity, with seizures and cardiac arrest. We present the case of an 85-year-old patient in total left knee replacement plan due to tibial saucer fracture, where systemic toxicity was observed by local anesthetics (LAST) after performing a femoral nerve block guided by neurostimulation and ultrasound with a solution of 20 ml of 0.525% ropivacaine + 0.6% lidocaine. As a positive data, the patient presented severe hypoalbuminemia

Los anestésicos locales son fármacos ampliamente utilizados para realizar bloqueos nerviosos periféricos. Los signos y síntomas de toxicidad pueden variar de leves a severos, incluidas la neuro y cardiotoxicidad, con convulsiones y paro cardíaco. Presentamos el caso de una paciente de 85 años de edad en plan de reemplazo total de rodilla izquierda debido a fractura de platillo tibial, donde se observó toxicidad sistémica por anestésicos locales (LAST por su sigla en inglés) después de realizar un bloqueo del nervio femoral guiado por neuroestimulación y ultrasonido con una solución de 20 ml de ropivacaína al 0,525% + lidocaína al 0,6%. Su único antecedente médico era presentar hipoalbuminemia severa.