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Anesthesia for Orthopedic Surgery
Orthopedic surgery challenges the anesthesia pro-vider. The comorbidities of these patients vary widely based on age group. Patients may present as neonates with congenital limb deformities, as teenagers with sports-related injuries, as adults for procedures ranging from excision of minor soft-tissue mass to joint replacement, or at any age with bone cancer. For example, patients with long bone fractures are predisposed to fat embolism syndrome. Patients are at increased risk for venous thromboembolism following pelvic, hip, and knee operations. Use of bone cement dur-ing arthroplasties can cause hemodynamic instabil-ity. Limb tourniquets limit blood loss but introduce additional risks.
Neuraxial and other regional anesthetic tech-niques play an important role in decreasing the incidence of perioperative thromboembolic com-plications, providing postoperative analgesia, and facilitating early rehabilitation and hospital discharge. Advances in surgical techniques, such as minimally invasive approaches to knee and hip replacement, are necessitating modifications in anesthetic and periop-erative management to facilitate overnight or even same-day discharge of patients who formerly required days of hospitalization.
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