THA

• Usually elderly Pt
• If a revision → ↑ blood loss and it takes longer→ Epidural or GA
• Look for the cause of arthritis → # due to CV disease (syncope) avascular necrosis
due steroids, infarction (sickle cell disease)
• Spinal Vs GA → less risk of PE with spinal and ↓ blood loss
A, B, C → look under elderly, and other co-existing diseases
• Consider Autologus blood donation
• Lab: ECG, CBC….. depend on the co-existing diseases
• If suspect a difficult A/W → GA, due to position
• Intra-op: risk of PE (cement, BM, fat) consider art-line in Pt with CV disease
• Post-op: need to anticoagulated, pain epidural or PCA
• DDx of circulatory collapse intra-op: PE, MI, total spinal, anaphylaxis
TKA
• Check for the reason: OA, R. arthritis, Ank spondylitis, hemophilia
• Ok to do spinal even you suspect a difficult A/W→ Pt is supine
• A,B, C → the under lying diseases
• Use of tourniquet → ↓ BP with release → consider PE in DDx
• Post-op: anticoagulation, pain control