Department of Anaesthesia, Peterborough and Stamford Hospitals NHS Trust Peterborough, UK and Chair, Working Party, Association of Anaesthetists, UK.
Department of Anaesthesia, Warrington and Halton Hospitals NHS Trust, Warrington, UK.
Anaesthesia. 2021 Feb;76(2):225-237. doi: 10.1111/anae.15291. Epub 2020 Dec 2.
We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.
我们代表麻醉师协会召集了一个多学科工作组，以更新 2011 年关于髋部骨折患者围手术期管理的指南。重要的是，这些指南描述了围手术期管理的核心目标和原则，建议将麻醉实践的标准化作为多学科护理的一个组成部分。尽管 2011 年指南的大部分内容仍然适用于当代实践，但新的证据和共识为本文件中的其他建议提供了信息。对 2011 年指南的具体修改涉及镇痛、法医学实践、风险评估、骨水泥植入综合征和区域审查网络。仍存在争议领域，我们进一步详细讨论了这些领域，涉及麻醉方式、手术延迟、血液管理和输血阈值、超声心动图、抗凝和抗血小板管理以及术后出院目的地。最后，这些指南提供了指向可在读者所在机构使用的补充在线材料、关键参考文献以及关于在 COVID-19 大流行期间髋部和假体周围骨折患者围手术期护理的英国国家指南的链接。
