Shoulder arthroplasty - Revision history

Tony.Wang at 22:21, 13 June 2022

2022-06-13T22:21:55Z

← Older revision		Revision as of 15:21, 13 June 2022
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	*Interscalene block as primary anesthetic or supplement to general anesthesia		*Interscalene block as primary anesthetic or supplement to general anesthesia
			*Can consider nerve catheter for intraop and postop pain management

	==Intraoperative management==		==Intraoperative management==

Chris.Rishel at 07:47, 5 April 2022

2022-04-05T07:47:04Z

← Older revision		Revision as of 00:47, 5 April 2022
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	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = General vs regional		\| anesthesia_type = General and/or regional
	\| airway = ETT ~~vs non-invasive O2~~		\| airway = ETT if GA
	\| lines_access = PIV ~~x 1-2 (~~opposite limb~~, large bore)~~		\| lines_access = PIV in opposite limb
	\| monitors = Standard, 5-lead ~~EKG, temperature~~		\| monitors = Standard
	\| considerations_preoperative = Type and screen~~, airway~~ and neurologic physical examination		5-lead ECG
	\| considerations_intraoperative = ~~Optimal BP management for~~ cerebral perfusion, VAE		Temperature
			\| considerations_preoperative = Type and screen
			Airway and neurologic physical examination
			Note baseline MAPs
			\| considerations_intraoperative = Maintain cerebral perfusion (MAP ±20% of baseline)
			VAE
	\| considerations_postoperative = Cerebrovascular accident		\| considerations_postoperative = Cerebrovascular accident
	}}'''Shoulder arthroplasty''' is a surgical procedure which replaces the humeral head with a prosthesis. Indications include pain associated with severe osteoarthritis and restoration of mobility<ref name=":0">{{Cite journal\|last=Ding\|first=David Y.\|last2=Mahure\|first2=Siddharth A.\|last3=Mollon\|first3=Brent\|last4=Shamah\|first4=Steven D.\|last5=Zuckerman\|first5=Joseph D.\|last6=Kwon\|first6=Young W.\|date=2017-12-01\|title=Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis\|url=https://www.sciencedirect.com/science/article/pii/S0972978X17301071\|journal=Journal of Orthopaedics\|language=en\|volume=14\|issue=4\|pages=417–424\|doi=10.1016/j.jor.2017.07.002\|issn=0972-978X\|pmc=PMC5537444\|pmid=28794581}}</ref>, and may be associated with avascular necrosis, rheumatoid arthritis (RA), trauma, or a rotator cuff tear<ref name=":0" /><ref name=":1" />.		}}'''Shoulder arthroplasty''' is a surgical procedure which replaces the humeral head with a prosthesis. Indications include pain associated with severe osteoarthritis and restoration of mobility<ref name=":0">{{Cite journal\|last=Ding\|first=David Y.\|last2=Mahure\|first2=Siddharth A.\|last3=Mollon\|first3=Brent\|last4=Shamah\|first4=Steven D.\|last5=Zuckerman\|first5=Joseph D.\|last6=Kwon\|first6=Young W.\|date=2017-12-01\|title=Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis\|url=https://www.sciencedirect.com/science/article/pii/S0972978X17301071\|journal=Journal of Orthopaedics\|language=en\|volume=14\|issue=4\|pages=417–424\|doi=10.1016/j.jor.2017.07.002\|issn=0972-978X\|pmc=PMC5537444\|pmid=28794581}}</ref>, and may be associated with avascular necrosis, rheumatoid arthritis (RA), trauma, or a rotator cuff tear<ref name=":0" /><ref name=":1" />.

Chris.Rishel: Reference fix

2022-03-27T05:38:56Z

Reference fix

← Older revision		Revision as of 22:38, 26 March 2022
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	}}'''Shoulder arthroplasty''' is a surgical procedure which replaces the humeral head with a prosthesis. Indications include pain associated with severe osteoarthritis and restoration of mobility<ref name=":0">{{Cite journal\|last=Ding\|first=David Y.\|last2=Mahure\|first2=Siddharth A.\|last3=Mollon\|first3=Brent\|last4=Shamah\|first4=Steven D.\|last5=Zuckerman\|first5=Joseph D.\|last6=Kwon\|first6=Young W.\|date=2017-12-01\|title=Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis\|url=https://www.sciencedirect.com/science/article/pii/S0972978X17301071\|journal=Journal of Orthopaedics\|language=en\|volume=14\|issue=4\|pages=417–424\|doi=10.1016/j.jor.2017.07.002\|issn=0972-978X\|pmc=PMC5537444\|pmid=28794581}}</ref>, and may be associated with avascular necrosis, rheumatoid arthritis (RA), trauma, or a rotator cuff tear<ref name=":0" /><ref name=":1" />.		}}'''Shoulder arthroplasty''' is a surgical procedure which replaces the humeral head with a prosthesis. Indications include pain associated with severe osteoarthritis and restoration of mobility<ref name=":0">{{Cite journal\|last=Ding\|first=David Y.\|last2=Mahure\|first2=Siddharth A.\|last3=Mollon\|first3=Brent\|last4=Shamah\|first4=Steven D.\|last5=Zuckerman\|first5=Joseph D.\|last6=Kwon\|first6=Young W.\|date=2017-12-01\|title=Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis\|url=https://www.sciencedirect.com/science/article/pii/S0972978X17301071\|journal=Journal of Orthopaedics\|language=en\|volume=14\|issue=4\|pages=417–424\|doi=10.1016/j.jor.2017.07.002\|issn=0972-978X\|pmc=PMC5537444\|pmid=28794581}}</ref>, and may be associated with avascular necrosis, rheumatoid arthritis (RA), trauma, or a rotator cuff tear<ref name=":0" /><ref name=":1" />.

	The procedure is typically performed using a deltopectoral incision. The head of the humerus is removed and a prosthesis is placed with or without cement. The glenoid's surface is smoothed and the glenoid prosthesis is placed. The humeral prothesis is fitted onto the glenoid prosthesis. After surgery, the patient is placed in a shoulder sling or immobilizer.<ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=~~Sixth edition~~\|location=Philadelphia\|oclc=1117874404}}</ref>		The procedure is typically performed using a deltopectoral incision. The head of the humerus is removed and a prosthesis is placed with or without cement. The glenoid's surface is smoothed and the glenoid prosthesis is placed. The humeral prothesis is fitted onto the glenoid prosthesis. After surgery, the patient is placed in a shoulder sling or immobilizer.<ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=6\|location=Philadelphia\|oclc=1117874404}}</ref>

	==Preoperative management==		==Preoperative management==

Chris.Rishel at 05:37, 27 March 2022

2022-03-27T05:37:40Z

← Older revision		Revision as of 22:37, 26 March 2022
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	==References==		==References==
			<references />
	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
	~~<references />~~
	[[Category:Orthopedic surgery]]		[[Category:Orthopedic surgery]]
	[[Category:Joint replacement surgery]]		[[Category:Joint replacement surgery]]
			[[Category:Shoulder surgery]]

Chris.Rishel at 06:01, 22 February 2022

2022-02-22T06:01:13Z

Show changes

Chris.Rishel: Text replacement - "|Respiratory" to "|Pulmonary"

2022-02-22T05:46:47Z

Text replacement - "|Respiratory" to "|Pulmonary"

← Older revision		Revision as of 22:46, 21 February 2022
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	\|Assess for valvular, conduction, and pericardial disease		\|Assess for valvular, conduction, and pericardial disease
	\|-		\|-
	\|~~Respiratory~~		\|Pulmonary
	\|Assess for pleural effusions, pulmonary fibrosis, involvement of cricoarytenoids, andTMJ due to RA		\|Assess for pleural effusions, pulmonary fibrosis, involvement of cricoarytenoids, andTMJ due to RA
	\|-		\|-

Chris.Rishel at 21:10, 21 February 2022

2022-02-21T21:10:37Z

← Older revision		Revision as of 14:10, 21 February 2022
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	<references />		<references />
	[[Category:Orthopedic surgery]]		[[Category:Orthopedic surgery]]
			[[Category:Joint replacement surgery]]

Chris.Rishel at 21:10, 21 February 2022

2022-02-21T21:10:06Z

← Older revision		Revision as of 14:10, 21 February 2022
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	[[Category:Surgical procedures]]		[[Category:Surgical procedures]]
			<references />
			[[Category:Orthopedic surgery]]

Cornel.Chiu at 03:21, 22 January 2022

2022-01-22T03:21:26Z

← Older revision		Revision as of 20:21, 21 January 2022
Line 1:		Line 1:
	{{Infobox surgical procedure		{{Infobox surgical procedure
	\| anesthesia_type = General		\| anesthesia_type = General vs regional
	\| airway = ETT		\| airway = ETT vs non-invasive O2
	\| lines_access = PIV x 1-2 (opposite limb, large bore)		\| lines_access = PIV x 1-2 (opposite limb, large bore)
	\| monitors = Standard, 5-lead EKG, temperature		\| monitors = Standard, 5-lead EKG, temperature
Line 9:		Line 9:
	}}		}}

	Shoulder arthroplasty is a surgical procedure involved with removal of the humeral head and replacement with a prosthesis. ~~Indication includes~~ pain associated with severe osteoarthritis. Patients experiences diagnosis of avascular necrosis, rheumatoid arthritis (RA), trauma, and rotator cuff tear. The procedure begins with a deltopectoral incision. The humerus head is removed and a prosthesis is placed with or without cement. The glenoid's surface is smoothed and the glenoid prosthesis is placed. The humeral prothesis is fitted onto the glenoid's prosthesis. Skin is closed and patient is placed in a shoulder sling or immobilizer <ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>		Shoulder arthroplasty is a surgical procedure involved with removal of the humeral head and replacement with a prosthesis. Indications include pain associated with severe osteoarthritis and restoration of mobility <ref name=":0">{{Cite journal\|last=Ding\|first=David Y.\|last2=Mahure\|first2=Siddharth A.\|last3=Mollon\|first3=Brent\|last4=Shamah\|first4=Steven D.\|last5=Zuckerman\|first5=Joseph D.\|last6=Kwon\|first6=Young W.\|date=2017-12-01\|title=Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis\|url=https://www.sciencedirect.com/science/article/pii/S0972978X17301071\|journal=Journal of Orthopaedics\|language=en\|volume=14\|issue=4\|pages=417–424\|doi=10.1016/j.jor.2017.07.002\|issn=0972-978X\|pmc=PMC5537444\|pmid=28794581}}</ref>. Patients experiences diagnosis of avascular necrosis, rheumatoid arthritis (RA), trauma, and rotator cuff tear<ref name=":0" /><ref name=":1" />. The procedure begins with a deltopectoral incision. The humerus head is removed and a prosthesis is placed with or without cement. The glenoid's surface is smoothed and the glenoid prosthesis is placed. The humeral prothesis is fitted onto the glenoid's prosthesis. Skin is closed and patient is placed in a shoulder sling or immobilizer <ref name=":1">{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>

	== Preoperative management ==		== Preoperative management ==
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	=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===		=== Regional and neuraxial techniques<!-- Describe any potential regional and/or neuraxial techniques which may be used for this case. If none, this section may be removed. --> ===

	* Interscalene block as ~~a supplement to general~~		* Interscalene block as primary anesthetic or supplemented with GA

	== Intraoperative management ==		== Intraoperative management ==
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	* If general is chosen, standard induction		* If general is chosen, standard induction
	** ETT		** ETT
			* If regional is chosen, moderate to deep sedation is reasonable

	=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===		=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===

	* Semi-sitting upright, beach chair		* Semi-sitting upright, beach chair
	* Table turned 90<sup>o</sup>

	=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===		=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
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	** Maintenance of neuromuscular blockade		** Maintenance of neuromuscular blockade
	* Maintain MAP within 20% of baseline to ensure adequate cerebral perfusion due to sitting position		* Maintain MAP within 20% of baseline to ensure adequate cerebral perfusion due to sitting position
	* Monitor ~~for~~ hemodynamic changes ~~associated with~~ VAE especially during ~~use~~ of cement		* Monitor hemodynamic changes or precordial doppler if used for VAE especially during placement of cement

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===

Cornel.Chiu at 20:14, 21 January 2022

2022-01-21T20:14:14Z

← Older revision		Revision as of 13:14, 21 January 2022
Line 4:		Line 4:
	\| lines_access = PIV x 1-2 (opposite limb, large bore)		\| lines_access = PIV x 1-2 (opposite limb, large bore)
	\| monitors = Standard, 5-lead EKG, temperature		\| monitors = Standard, 5-lead EKG, temperature
	\| considerations_preoperative =		\| considerations_preoperative = Type and screen, airway and neurologic physical examination
	\| considerations_intraoperative = Optimal BP management for cerebral perfusion, VAE		\| considerations_intraoperative = Optimal BP management for cerebral perfusion, VAE
	\| considerations_postoperative = Cerebrovascular accident		\| considerations_postoperative = Cerebrovascular accident
	}}		}}

	Shoulder arthroplasty is a surgical procedure involved with removal of the head ~~of the humerus~~ and replacement with a prosthesis. Indication includes pain associated with severe osteoarthritis. Patients experiences diagnosis of avascular necrosis, rheumatoid arthritis, trauma, and rotator cuff tear. The procedure begins with a deltopectoral incision. The humerus head is removed and a prosthesis is placed with or without cement. The glenoid's surface is smoothed and the glenoid prosthesis is placed. The humeral prothesis is fitted onto the glenoid's prosthesis. Skin is closed and patient is placed in a shoulder sling or immobilizer <ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>		Shoulder arthroplasty is a surgical procedure involved with removal of the humeral head and replacement with a prosthesis. Indication includes pain associated with severe osteoarthritis. Patients experiences diagnosis of avascular necrosis, rheumatoid arthritis (RA), trauma, and rotator cuff tear. The procedure begins with a deltopectoral incision. The humerus head is removed and a prosthesis is placed with or without cement. The glenoid's surface is smoothed and the glenoid prosthesis is placed. The humeral prothesis is fitted onto the glenoid's prosthesis. Skin is closed and patient is placed in a shoulder sling or immobilizer <ref>{{Cite book\|url=https://www.worldcat.org/oclc/1117874404\|title=Anesthesiologist's manual of surgical procedures\|date=2020\|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu\|isbn=978-1-4698-2916-6\|edition=Sixth edition\|location=Philadelphia\|oclc=1117874404}}</ref>

	== Preoperative management ==		== Preoperative management ==
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	\|-		\|-
	\|Cardiovascular		\|Cardiovascular
	\|		\|Assess for valvular, conduction, and pericardial disease
	\|-		\|-
	\|Respiratory		\|Respiratory
	\|		\|Assess for pleural effusions, pulmonary fibrosis, involvement of cricoarytenoids, andTMJ due to RA
	\|-
	~~\|Gastrointestinal~~
	\|
	\|-		\|-
	\|Hematologic		\|Hematologic
	\|		\|Assess for chronic anemia
	\|-
	~~\|Renal~~
	\|
	\|-		\|-
	\|Endocrine		\|Endocrine
Line 47:		Line 41:

	* Type and screen		* Type and screen

	=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===

	=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===		=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
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	* 5-lead EKG		* 5-lead EKG
	* PIV x 1-2 (opposite limb, large bore)		* PIV x 1-2 (opposite limb, large bore)
			* +/- arterial line
	* Consider precordial doppler given the risk of venous air embolism in the semi-sitting/beach chair position		* Consider precordial doppler given the risk of venous air embolism in the semi-sitting/beach chair position

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	** Maintenance of neuromuscular blockade		** Maintenance of neuromuscular blockade
	* Maintain MAP within 20% of baseline to ensure adequate cerebral perfusion due to sitting position		* Maintain MAP within 20% of baseline to ensure adequate cerebral perfusion due to sitting position
			* Monitor for hemodynamic changes associated with VAE especially during use of cement

	=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===		=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
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	!		!
	!Total shoulder arthroplasty		!Total shoulder arthroplasty
	~~!Reverse Shoulder Arthroplasty~~
	\|-		\|-
	\|Unique considerations		\|Unique considerations
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	* Sitting position		* Sitting position
	* Methyl methacrylate cement can cause severe hypotension/VAE		* Methyl methacrylate cement can cause severe hypotension/VAE
	\|
	\|-		\|-
	\|Position		\|Position
	\|Semi-sitting/beach chair		\|Semi-sitting/beach chair
	\|
	\|-		\|-
	\|Surgical time		\|Surgical time
	\|2-5 hours		\|2-5 hours
	\|
	\|-		\|-
	\|EBL		\|EBL
	\|200-1000 mL		\|200-1000 mL
	\|
	\|-		\|-
	\|Postoperative disposition		\|Postoperative disposition
	\|Floor		\|Floor
	\|
	\|-		\|-
	\|Pain management		\|Pain management
	\|moderate-severe		\|moderate-severe
	\|
	\|-		\|-
	\|Potential complications		\|Potential complications
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	* VAE		* VAE
	* brachial plexus injury		* brachial plexus injury
	\|
	\|}		\|}