Tổng gây mê cho các hoạt động trên tử cung và buồng trứng cũng tương tự như mô tả trong bụng gây mê (Chương 24). Gây tê vùng là một kỹ thuật tuyệt vời cho các phẫu thuật phụ khoa, với lợi ích của thuốc giảm đau sau mổ tốt. Innervation của tử cung lên đến T10. | emedicina 26 Anaesthesia for orthopaedic surgery In the bad old days a trainee anaesthetist spent long hours in the evening and night watching young orthopaedic surgeons struggle with emergency cases. Fortunately it has been agreed that patients with for example hip fractures need their surgery performed as soon as practically possible but in the safest environment. The National Confidential Enquiry into Perioperative Deaths NCEPOD recommends that such surgery should not be carried out by inexperienced surgeons and anaesthetists in the night. This work should be done on designated trauma lists during the day by appropriately trained staff. General considerations The general considerations of anaesthesia for orthopaedic surgery are shown in Box . Box General considerations in orthopaedic anaesthesia Age Trauma or elective Concomitant injury or disease Use of tourniquet Infection Haemorrhage Methylmethacr ylate cement Deep vein thrombosis prophylaxis Fat embolism The extremes of the age range appear for orthopaedic surgery. Young people present commonly with trauma whilst elderly patients often present for joint arthroplasty or with a fractured femoral neck. Age is not a contraindication to surgery and you should learn to assess patients in terms of their biological age and not chronological age. Providing there are no major medical problems elderly patients with hip fractures should have surgery on the earliest available trauma list. 152 emedicina Anaesthesia for orthopaedic surgery Otherwise bed rest is associated with weakness confusion chest infection and deep vein thrombosis and recovery from the delayed surgery is prolonged. Postoperative mortality and morbidity remain high in these patients. After major trauma emergency surgery on patients with compound fractures is common. Associated spinal and neck injuries must be sought and appropriate treatment instituted before induction of anaesthesia. Traumatic injuries such as fractured ribs and a fractured .
