Implementation and results of an enhanced recovery (fast-track) program in total knee replacement patients at a French university hospital.

Introduction: In total knee replacement (TKR) surgeries, "fast-track" or enhanced recovery after surgery (ERAS) programs are being developed, but their impact on care pathway quality and safety has not been fully explored in the French literature. The present study aimed to compare results in TKR between fast-track and conventional pathways, addressing the following questions: (1) Are 90-day rates of complications, readmission and surgical revision higher with fast-track? (2) Is mean length of stay (LoS) shorter with fast-track? (3) Are postoperative pain and clinical results improved by fast-track? And, (4) are patients and care staff satisfied with these new programs?

Hypothesis: Implementing fast-track for TKR in a university hospital center is beneficial for the patient and does not impair the quality and safety of care.

Patients And Method: A case-control study was performed using a retrospective analysis of prospectively collected data.

A targeted remifentanil administration protocol based on the analgesia nociception index during vascular surgery.

Background: The intraoperative modulation of opioids continues to be based on clinical signs. This may result in adverse events such as sympathetic reactivity or opioid-induced hyperalgesia. Recently, the Analgesia/Nociception Index (ANI), a non-invasive 0-100 index derived from heart rate variability analysis, has been proposed for nociception assessment.

Thromboprohylaxis in orthopedic surgery and traumatology.

Orthopaedic and trauma surgery are classified according 3 groups of venous thromboembolic risk. Elective total hip replacement (THR) or total knee replacement (TKR), hip fracture surgery or trauma patients are at high risk. Isolated lower extremity injury with fracture is at moderate risk whereas this risk is low without fracture as well as with knee arthroscopy.

Aprotinin versus placebo in major orthopedic surgery: a randomized, double-blinded, dose-ranging study.

Unlabelled: We conducted a prospective, multicenter, double-blinded, dose-ranging study to compare the risk/benefit ratio of large- and small-dose aprotinin with placebo after major orthopedic surgery. Fifty-eight patients were randomized into three groups: Large-Dose Aprotinin (4 M kallikrein inactivator unit [KIU] bolus before surgery followed by a continuous infusion of 1 M KIU/h until the end of surgery), Small-Dose Aprotinin (2 M KIU bolus plus 0.5 M KIU/h), and Placebo.

Contribution of laboratory tests, scintigraphy, and histology to the diagnosis of lower limb joint replacement infection.

Objective: To evaluate the contribution of laboratory tests, histology and scintigraphy for diagnosing and monitoring the treatment of lower limb arthroplasty infection.

Patients And Methods: 37 lower limb arthroplasties, 20 at the hip and 17 at the knee, were studied. Investigations included laboratory tests for inflammation (erythrocyte sedimentation rate, C-reactive protein, haptoglobin, and orosomucoid), histology (presence of neutrophils) and scintigraphy (99m Tc-HMDP bone scan, colloidal sulfide bone marrow scan, and 99m Tc-HMPAO leukocyte scan).

[Echo-Doppler for early diagnosis of deep venous thrombosis in orthopedic surgery and traumatology. A retrospective study of 1,647 patients].

Unlabelled: The authors report the results of duplex ultrasound scanning investigation for the detection of deep venous thrombosis after orthopedic surgery and compare asymptomatic and symptomatic populations.

Purpose Of The Study: To estimate the rate of deep venous thrombosis diagnosed by duplex scanning in those 2 populations and precise their features.

Material: A total of 1,647 in-patients all receiving low-molecular-weight heparin and investigated from 1989 to 1993.

[Cardiac tamponade and central venous catheterization].

A 32-year-old female patient was operated on for a residual colonic stricture occurring after hemicolectomy. A right internal jugular central venous catheter was inserted during the anaesthetic for postoperative parenteral feeding. The anaesthetic combined both general and epidural anaesthesia, the latter being continued for postoperative analgesia (10 ml.