[Fat embolism syndrome after surgery to replace the femoral stem of a hip prosthesis]. / Síndrome de embolia grasa tras recambio de vástago femoral de prótesis de cadera.

A 66-year-old woman developed hemodynamic instability, oliguria, prostration, fever, and coagulopathy 4 hours after surgery to replace the femoral stem component of a hip prosthesis under a combined subarachnoid-epidural block. Dyspnea and tachypnea developed, and a petechial rash appeared 24 hours later. The diagnosis was fat embolism after other possible causes were ruled out. Supplementary oxygen, fluid replacement therapy, and inotropic support were started. The patient's condition improved and she was discharged from the postoperative recovery unit 5 days after admission. Although fat embolism usually appears in young men after large bone fractures, it should be considered when symptoms consistent with this diagnosis arise in patients who have undergone orthopedic surgery so that appropriate treatment can be started early.

Síndrome de embolia grasa tras recambio de vástago femoral de prótesis de cadera / Fat embolism syndrome after surgery to replace the femoral stem of a hip prosthesis

Una paciente de 66 años, cuatro horas después de la realización de un recambio de vástago de cadera bajo bloqueo combinado subaracnoideo-epidural, presentó un cuadro de inestabilidad hemodinámica, oliguria, postración, pico febril y trastorno de la coagulación. La clínica progresó a disnea y taquipnea, acompañadas de un rash petequial de aparición tardía (transcurridas más de 24 horas). Tras descartar otras posibles etiologías, fue diagnosticada de síndrome de embolia grasa. Se instauró tratamiento de soporte con oxígeno suplementario, reposición de líquidos y apoyo inotrópico. La evolución de la paciente fue favorable, pudiendo ser dada de alta de la Unidad de Reanimación Postoperatoria tras 5 días de ingreso. Aunque esta entidad aparece generalmente en varones jóvenes tras fracturas de huesos largos, debemos considerar su presencia en pacientes sometidos a cirugía ortopédica con una clínica compatible, para instaurar precozmente las medidas terapéuticas oportunas (AU)

[Transfusion needs during intraoperative and immediate postoperative periods in arthroplasty of the hip and knee]. / Necesidades transfusionales durante el intra y postoperatorio inmediato de la artroplastia de cadera y rodilla. Incidencia y factores asociados.

OBJECTIVES: To determine the factors associated with immediate perioperative transfusion requirements of hip or knee arthroplasty patients who have not been enrolled in a blood salvage program. PATIENTS AND METHODS: This prospective study collected demographic (age, sex, weight, height, etc.), physiological (hemoglobin levels, coagulation times, preoperative platelet counts, etc.), clinical history and anesthetic and surgical data (type of anesthesia, surgical diagnosis, duration of procedure) in 112 patients undergoing orthopedic surgery: 19 cases of primary knee arthroplasty, 77 cases of hip arthroplasty and 16 replacements of hip arthroplasty. Logistic regression analysis of the aforementioned variables was performed to search for factors related to transfusional needs during and after hip arthroplasty or after knee arthroplasty, which was performed with a tourniquet applied to render intraoperative transfusion unnecessary. RESULTS: The variables that increased the risk of transfusion during surgery were duration of procedure exceeding 120 min (OR 15.24; p = 0.01) and loss of over 500 ml of blood during surgery (OR 11.4; p = 0.02). The variables associated with perioperative transfusion were loss of over 500 ml in the postanesthetic recovery room (OR 12.6; p < 0.0001), hypotensive episodes during recovery (OR 11.7; p = 0.0001), prosthetic replacement (OR 6.33; p = 0.005), height < 160 cm (OR 5.03; p = 0.02), preoperative hemoglobin level < 13.5 g/dl (OR 4.97; p = 0.02), and surgery for reasons other than osteoarthritis (arthritis, pathological fractures, etc.) (OR 4.60; p = 0.04). Variables associated with transfusion of over two units of packed red cells were a history of neoplastic disease unrelated to arthroplasty (OR 378.67; p = 0.005), prosthetic replacement (OR 49.71; p = 0.009), diabetes (OR 36.49; p = 0.02) and a hypotensive event while in the postanesthetic recovery room (OR 29.12; p = 0.02). CONCLUSION: These results suggest that certain modifiable factors increase the risk of blood transfusion in knee and hip arthroplasty. Specifically, they are duration of surgery, intra- and postoperative bleeding, preoperative hemoglobin level and instances of perioperative hypotension. Other factors outside our control are height or patient clinical history.