Anesthesia for total hip arthroplasty

Recent advances in anesthetic care for patients undergoing total hip arthroplasty are summarized. Epidural and spinal anesthesia are associated with reduced perioperative blood loss and lower deep vein thrombosis rates. A new technique of inducing hypotension with epidural anesthesia is described. This technique is associated with low rates of deep vein thrombosis, blood transfusions, and enhanced cement-bone interface. Pulmonary fat-marrow embol i can now be assessed with echocardiography and changes in pulmonary artery pressure. Management strategies are also addressed and new techniques of postoperat ive pain control are discussed. In the past few years, the mortality rate following total hip arthroplasty has fal len to 0.1% at The Hospital For Special Surgery in New York City using hypotensive epidural anesthesia, ppropriate perioperat ive hemodynamic monitor ing, and rat ional postoperat ive pain control .