Anesthesia and perioperative medicine in orthopedic surgery

Ay anesthesia for orthopedic surgery is challenging for anesthesiologist from the patient's perspective, the type of surgery as well as the patient's position during the surgery. Patients may be old with numerous comorbidities but also young, healthy trauma patients who have associated injuries that can have a significant impact on the type of anesthesia. Therefore, it is imperative that the anesthesiologist in orthopedic surgery examine the entire patient and not just focus on the area of surgery, but also to make an adequate preoperative assessment and preparation. In the preoperative preparation of orthopedic patients cardiological, pulmological and neurological evaluation is most often needed, nasal screening and decolonization, preoperative skin preparation, glycemic control and the use of antibiotic prophylaxis. Patients undergoing major orthopedic surgery are at highest risk for venous thromboembolism both during and after surgery, so that the timing of thromboprophylaxis as well as its continuation in orthopedic patients is of exceptional importance. For the optimal use of adequate thromboprophylaxis there are several published guidelines with clear recommendations for daily clinical practice. Understanding the type and course of the surgery as the patient position during surgery provide adequate working conditions with minimal blood loss and complications. Reduction of bleeding, as intraoperatively and postoperatively have been achieved by normovolemic hypotension, tourniquet, but also by topical or systemic application of tranexamic acid.As a surgery with high postoperative requirements in analgesia within the multimodal approach, besides the peripheral nerve blocks, the periarticular injection of local anesthetics is increasingly used in everyday work. Knowing the specificity and requirements of an orthopedic surgery with adequate preoperative preparation, selection of anesthesia type and intraoperative plan in order to reduce intraoperative bleeding requires adapting to each patient individually.