………………..…………………………………………………………………………………………………………………………………….. Orthopedic Surgery for Adults with Cerebral Palsy- Medical Considerations American Academy for Cerebral Palsy and Developmental Medicine, 2013, IC 6 Garey Noritz, MD, FAAP, FACP Nationwide Children’s Hospital The Ohio State University Columbus, Ohio, USA ………………..…………………………………………………………………………………………………………………………………….. Disclosures In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in my presentation. This presentation will include discussion of • thromboembolic prophylaxis regimens • Pain control options that have not been approved by the FDA (US) ………………..…………………………………………………………………………………………………………………………………….. Objectives At the end of this presentation, the attendees will be able to 1. Plan Preoperative Assessment for Adults with Cerebral Palsy who will undergo orthopedic procedures. 2. Choose Prophylaxis (if appropriate) against Deep Vein Thrombosis 3. Plan postoperative control of pain ………………..…………………………………………………………………………………………………………………………………….. Adults with Cerebral Palsy Reid, 2012
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Orthopedic Surgery for Adults with Disclosures Cerebral ... · Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary
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From: Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline f rom the American College of Physicians
Ann Intern Med. 2006;144(8):575-580. doi:10.7326/00 03-4819-144-8-200604180-00008
American Society of Anesthesiologists Classificatio n
From: Obstructive Sleep Apnea Syndrome and Postoperative Complications: Clinical Use of the STOP-BANG Questionnaire
Arch Otolaryngol Head Neck Surg. 2010;136(10):1020-1024. doi:10.1001/archoto.2010.1020
The STOP-BANG (Snoring, Tiredness during daytime, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, Gender) questionnaire. A high risk of sleep apnea is defined as a score of 3 or more; low risk of sleep apnea, a score of
Figure 1. Cardiac evaluation and care algorithm for noncardiac surgery based on active clinical conditions, known cardiovascular disease, or cardiac risk factors for patients 50
years of age or greater. *See Table 2 for active clinical conditions. †See Clas...
Fleisher L A et al. Circulation 2007;116:e418-e500
Hospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE)even before the diagnosis is suspected. Therefore, the best approach is for every patient to be evaluated for primary prophylaxis since preventing DVT is essential to reducing morbidity and mortality associated with PE. There is good evidence that appropriately used thromboprophylaxis has a desirable risk/benefit ratio and is cost-effective. Thromboprophylaxis provides an opportunity to improvepatient outcomes and reduce hospital costs. Complications from prophylactic anticoagulation, especially bleeding, have not beensupported by the results from many metanalyses and randomized clinical trials. Uniform uses of electronic alerts or local thromboprophylaxis guidelines are associated with improvements in both prophylaxis provision and patients’ outcomes.
Adesanya, A. O., W. Lee, et al. (2010). "Perioperative Management of Obstructive Sleep Apnea." CHEST Journal 138(6): 1489-1498.
Falck-Ytter, Y., C. W. Francis, et al. (2012). "Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines." Chest 141(2 Suppl): e278S-325S.
Fleisher, L. A., J. A. Beckman, et al. (2007). "ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery." Circulation 116(17): e418-e500.
Greenwald, L. J., M. T. Yost, et al. (2012). "The role of clinically significant venous thromboembolism and thromboprophylaxis in pediatric patients with pelvic or femoral fractures." J Pediatr Orthop 32(4): 357-361.
Jackson, P. C. and J. M. Morgan (2008). "Perioperative thromboprophylaxis in children: development of a guideline for management." Pediatric Anesthesia 18(6): 478-487.
Qaseem, A., V. Snow, et al. (2006). "Risk Assessment for and Strategies To Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline from the American College of Physicians." Annals of Internal Medicine 144(8): 575-580.
Vasu Ts, D. K. C. R. and et al. (2010). "Obstructive sleep apnea syndrome and postoperative complications: Clinical use of the stop-bang questionnaire." Archives of Otolaryngology—Head & Neck Surgery 136(10): 1020-1024.