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Deep Vein Thrombosis (DVT)/ Venous Thromboembolism (VTE)
Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism E. O. Pearse, MA, FRCS(Orth), Specialist Registrar in Orthopaedics, Clinical Knee Fellow; B FCalwelll, FRACS(Orth), Orthopaedic Surgeon; R. J. Lockwood, BHlth Sc(Nursing), RN Surgical Nursing Unit Manager; and Holland, BMed(Hons), FANZCA, Consultant Anaesthetist 2007 British Editorial Society of Bone and Joint Surgery
We carried out an audit on the result of achieving early walking in total knee replacement after instituting a new rehabilitation protocol, and assessed its influence on the development of deep-vein thrombosis as determined by Doppler ultrasound scanning on the fifth post-operative day. Early mobilisation was defined as beginning to walk less than 24 hours after knee replacement.
Between April 1997 and July 2002, 98 patients underwent a total of 125 total knee replacements. They began walking on the second post-operative day unless there was a medical contraindication. They formed a retrospective control group. A protocol which allowed patients to start walking at less than 24 hours after surgery was instituted in August 2002. Between August 2002 and November 2004, 97 patients underwent a total of 122 total knee replacements. They formed the early mobilisation group, in which data were prospectively gathered. The two groups were of similar age, gender and had similar medical comorbidities. The surgical technique and tourniquet times were similar and the same instrumentation was used in nearly all cases. All the patients received low-molecular-weight heparin thromboprophylaxis and wore compression stockings post-operatively.
In the early mobilisation group 90 patients (92.8%) began walking successfully within 24 hours of their operation. The incidence of deep-vein thrombosis fell from 27.6% in the control group to 1.0% in the early mobilisation group (chi-squared test, p < 0.001). There was a difference in the incidence of risk factors for deep-vein thrombosis between the two groups. However, multiple logistic regression analysis showed that the institution of an early mobilisation protocol resulted in a 30-fold reduction in the risk of post-operative deep-vein thrombosis when we adjusted for other risk factors.
Received May 31, 2006. Accepted December 1, 2006.
Prevention of Venous Thromboembolism in Surgical Patients
Giancarlo Agnelli, MD. (Circulation. 2004; 110[suppl IV]: IV-4–IV-12.)
Abstract—Venous thromboembolism (VTE) is a common complication of surgical procedures. The risk for VTE in surgical patients is determined by the combination of individual predisposing factors and the specific type of surgery. Prophylaxis with mechanical and pharmacological methods has been shown to be effective and safe in most types of surgery and should be routinely implemented. For patients undergoing general, gynaecologic, vascular, and major urologic surgery, low-dose unfractionated heparin or low-molecular-weight heparin (LMWH) are the options of choice.
For low-risk urologic surgery, early postoperative mobilization of patients is the only intervention warranted. For higher-risk patients, including those undergoing elective hip or knee replacement and surgery for hip fracture, vitamin K antagonists, LMWH, or fondaparinux are recommended.
For patients undergoing neurosurgery, graduated elastic stockings are effective and safe and may be combined with LMWH to further reduce the risk of VTE. The role of prophylaxis is less defined in patients undergoing elective spine surgery, as well as laparoscopic and arthroscopic surgery. A number of issues related to prophylaxis of VTE after surgery deserve further clarification, including the role of screening for asymptomatic deep vein thrombosis, the best timing for initiation of pharmacological prophylaxis, and the optimal duration of prophylaxis in high-risk patients
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Anaemia is usually caused by a decrease in number of red blood cells (RBCs) or less than the normal quantity of haemoglobin in the blood.
Blood is made up of a number of cells and the plasma that they travel in. RBCs contain a chemical called haemoglobin. Haemoglobin is attracted to oxygen and the two substances can bind together. This allows oxygen to be transported by red blood cells from the lungs to all parts of the body.
Symptoms may include breathlessness and increased fatigue. Most doctors’ recommend taking an iron supplement and increasing the foods that have high iron levels e.g. red meat and leafy greens. Iron is an important factor in anaemia because this mineral is used to make haemoglobin. The component of red blood cells that attaches to oxygen and transports it. Red blood cells exist only to oxygenate the body and have a life span of about 120 days.
Constipation can a common complaint post abdominal surgery. The longer it takes for digested food to pass through the bowel the more water is reabsorbed within the large intestine and the harder the stool becomes.
There are a number of things that you can do to possibly alleviate or reduce the effects of this condition. Drink 2-3 L of water per day, the first one of the day warm with a squeeze of lemon juice, this is very cleansing to both the liver and the intestines. Increase your fruit, vegetable and fiber intake. Try having muesli made from raw oats, nuts and seeds with a few prunes on top in the morning for breakfast. Dried prunes should be soaked in water overnight in the fridge.
Haemorrhoids are swellings that can occur in the anus and lower rectum.
There is a network of small veins within the lining of the anus and lower rectum. These veins sometimes become engorged with more blood than usual. These engorged veins and the overlying tissue may then form into one or more small swellings called haemorrhoids.
A number of ointments and creams are available over the counter from your pharmacist to assist in decreasing discomfort.
Hypoglycaemia (low blood sugar)
Hypoglycemia occurs when blood sugar levels drop too low and there is not enough glucose in the system to provide for your body enough energy.
The signs of hypoglycaemia do not vary that much from the symptoms associated with hypoglycaemia associated with diabetes. These symptoms include shaking, profuse sweating, nervous and anxiety attacks, intense hunger, dizziness, extreme headache, confusion, changes in vision and sudden irritability.
Hypotension (Low Blood Pressure)
Blood pressure is a measurement of the pressure in your arteries during the active and resting phases of each heartbeat.
Systolic pressure. The first (top) number in a blood pressure reading, this is the amount of pressure your heart generates when pumping blood through your arteries to the rest of your body.
Diastolic pressure. The second (bottom) number in a blood pressure reading, this refers to the amount of pressure in your arteries when your heart is at rest between beats.
Low blood pressure is caused by dehydration. When you become dehydrated, your body loses more water than it takes in. Even mild dehydration can cause low blood pressure, dizziness and fatigue. Maintaining adequate hydration will help to reduce symptoms of low blood pressure post-surgery.
Hypertension (High Blood Pressure)
An acute temporary increase in blood pressure that develops within 30-90 min following an operation and continues for up to 8 hours. Systolic pressure > 160 mmHg or Diastolic Pressure > 90 mm Hg or an increase of 40-50 mm Hg in systolic blood pressure (BP) or post-operative BP greater than 15-20% above baseline.
Indigestion, also known as dyspepsia, is pain or discomfort in the upper abdomen .If you have indigestion; you may experience a number of symptoms. Heartburn or acid reflux is a burning sensation in the oesophagus that is caused by acid passing from the stomach. Regurgitation of food and bloating is also common.
A number of lifestyle changes may help improve the symptoms of indigestion, such as eating smaller meals or cutting out certain foods. There are also medicines, such as antacids, that can be taken safely during pregnancy to treat indigestion.
Nausea and Vomiting
Nausea and vomiting is very common after surgery. In more cases, an anti-sickness medicine (anti-emetic) is used to stop this. Dehydration is a complication in severe cases. See your medical practitioner if you suspect that you are becoming dehydrated.
Urinary tract infection (UTI)
A urinary tract infection (UTI), also called bladder infection, is a bacterial infection within the urinary tract.
The most common symptoms are a feeling of wanting to go to the toilet a lot without passing much urine and during micturition you may experience a burning sensation.
UTI's can be safely and commonly treated with a 5-7 day course of antibiotics.