Journal of shoulder and elbow surgery
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J Shoulder Elbow Surg · Jan 2015
Association between temporal mean arterial pressure and brachial noninvasive blood pressure during shoulder surgery in the beach chair position during general anesthesia.
Estimation of cerebral perfusion pressure during elective shoulder surgery in the beach chair position is regularly performed by noninvasive brachial blood pressure (NIBP) measurements. The relationship between brachial mean arterial pressure and estimated temporal mean arterial pressure (eTMAP) is not well established and may vary with patient positioning. Establishing a ratio between eTMAP and NIBP at varying positions may provide a more accurate estimation of cerebral perfusion using noninvasive measurements. ⋯ The eTMAP-to-NIBP ratio decreases as an anesthetized patient is placed into the beach chair position. Awareness of this phenomenon is important to ensure adequate cerebral perfusion and prevent hypoxic-related injuries.
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J Shoulder Elbow Surg · Jan 2015
Thirty-day morbidity and mortality after elective total shoulder arthroplasty: patient-based and surgical risk factors.
Total shoulder arthroplasty (TSA) is an effective treatment for painful glenohumeral arthritis, but its morbidity has not been thoroughly documented. ⋯ Whereas TSA has low short-term rates of perioperative complications and mortality, careful perioperative medical optimization and efficient surgical technique should be emphasized to decrease morbidity and mortality.
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J Shoulder Elbow Surg · Jan 2015
Preoperative opioid use and outcomes after reverse shoulder arthroplasty.
The potential adverse effect of preoperative opioid use on outcomes after reverse shoulder arthroplasty (RSA) has not been investigated. The purpose of this study was to evaluate outcomes after RSA in patients with a history of preoperative opioid use and compare them with a control group without a history of preoperative opioid use. ⋯ Improvements can be expected in patients with a history of preoperative opioid use; however, patients with preoperative opioid use have a lower preoperative baseline and should not expect to reach the same peak outcome scores after RSA as patients without a history of preoperative opioid use.
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J Shoulder Elbow Surg · Jan 2015
The epidemiology of closed reduction for simple elbow dislocations and the incidence of early subsequent open reduction.
Simple elbow dislocations are often treated with closed reduction (CR); however, the rate of CR failure and factors that may predict failure have been largely underinvestigated. The objectives of this study were (1) to determine the incidence of elbow dislocations treated by CR in a universal health care system and (2) to identify patient characteristics associated with failed CR, defined as the subsequent need for open reduction. ⋯ Young men are at highest risk for CR for simple elbow dislocations; however, older patients are more likely to require open intervention, as are those with markers of a difficult reduction signifying potentially greater soft tissue damage. A comprehensive understanding of the epidemiology of simple elbow dislocation will aid management decisions.
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J Shoulder Elbow Surg · Jan 2015
Management of deep postoperative shoulder infections: is there a role for open biopsy during staged treatment?
Despite the gold standard treatment of 2-stage exchange arthroplasty, reinfection after periprosthetic shoulder infections and periarticular osteomyelitis can be as high as 37%. This study describes a protocol to detect persistent deep shoulder infection before revision arthroplasty. ⋯ Despite prior staged treatment for deep postoperative shoulder infections, specimens obtained from open biopsy before replantation detected a persistent infection rate of 22% in all patients and 38% in patients with P acnes infection, which may indicate a role for this procedure in the prevention of recurrent infections.