RESUMO
Intramedullary nail fixation is a common treatment for metastatic tumors of the femur with overt or impending femoral fracture. This procedure sometimes causes severe cardiorespiratory and vascular dysfunction. The clinical relevance of this is not dear. We reviewed 45 operations in 43 patients, where intramedullary nail fixation was used to treat metastatic femoral fractures and impending fractures. We studied the incidence of intraoperative oxygen desaturation and hypotension associated with intramedullary manipulation as markers of cardiorespiratory and vascular dysfunction. Acute oxygen desaturation and hypotension occurred in 11 of our 45 patients. Of these, 3 died, 2 required intensive care postoperatively and 6 made uneventful recoveries. We hope to highlight a serious complication in this patient group.
Assuntos
Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Neoplasias Femorais/complicações , Neoplasias Femorais/secundário , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Hipotensão/etiologia , Hipóxia/etiologia , Complicações Intraoperatórias/etiologia , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos/efeitos adversos , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fixação Intramedular de Fraturas/métodos , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Hipotensão/mortalidade , Hipóxia/mortalidade , Incidência , Complicações Intraoperatórias/mortalidade , Masculino , Pessoa de Meia-Idade , Morbidade , Radiografia , Estudos Retrospectivos , SíndromeRESUMO
Postoperative pain in children with spastic cerebral palsy (CP) is often attributed to muscle spasm and is difficult to manage using opiates and benzodiazepines. Adductor-release surgery to treat or prevent hip dislocation in children with spastic CP is frequently performed and is often accompanied by severe postoperative pain and spasm. A double-blinded, randomized, placebo-controlled clinical trial of 16 patients (mean age 4.7 years) with a mainly spastic type of CP (either diplegic or quadriplegic in distribution) was used to test the hypothesis that a significant proportion of postoperative pain is secondary to muscle spasm and, therefore, might be reduced by a preoperative chemodenervation of the target surgical muscle by intramuscular injection of botulinum toxin A (BTX/A). Compared with the placebo, BTX/A was found to be associated with a reduction in mean pain scores of 74% (P<0.003), a reduction in mean analgesic requirements of approximately 50% (P<0.005), and a reduction in mean length of hospital admission of 33% (P<0.003). It was concluded that an important component of postoperative pain in the patient population is due to muscle spasm and this can be managed effectively by preoperative injection with BTX/A. These findings may have implications for the management of pain secondary to muscle spasm in other clinical settings.