Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina
-
Review Comparative Study
The assessment of acid-base analysis: comparison of the "traditional" and the "modern" approaches.
Three distinct approaches are currently used in assessing acid-base disorders: the traditional - physiological or bicarbonate-centered approach, the base-excess approach, and the "modern" physicochemical approach proposed by Peter Stewart, which uses the strong ion difference (particularly the sodium chloride difference) and the concentration of nonvolatile weak acids (particularly albumin) and partial pressure of carbon dioxide (pCO(2)) as independent variables in the assessment of acid-base status. The traditional approach developed from the pioneering work of Henderson and Hasselbalch and the base-excess are still most widely used in clinical practice, even though there are a number of problems identified with this approach. ⋯ Although Stewart's approach has been largely ignored by physiologists, it is increasingly used by anesthesiologists and intensive care specialists, and is recommended for use whenever serum's total protein, albumin or phosphate concentrations are markedly abnormal, as in critically ill patients. Although different in their concepts, the traditional and modern approaches can be seen as complementary, giving in principle, the same information about the acid-base status.
-
Hip replacement surgery is a common and effective procedure for the relief of pain and loss of function. The number of procedures is increasing and great interest is shown for the manner of outcome improvement following hip replacement surgery. Last decade (2001-2010) is declared as the Bone and Joint Decade and has been characterized by many innovations in hip replacement surgery including minimally invasive technique but also by improvements in anesthetic technique. ⋯ The possible techniques of postoperative pain therapy are also presented. The importance of thromboprophylaxis is outlined and recent guidelines for thromboprophylaxis are given including recommendations for new antithrombotic drugs. Our recommendation is to always prepare a patient for this procedure, analyse preoperative status, choose optimal anesthetic technique, provide thromboprophylaxis and multimodal pain therapy according to accepted guidelines.