Arthroplasty anaesthesia, ERAS, and blood conservation

Model answer

Framing. Arthroplasty ERAS combines optimised comorbidities, preferred neuraxial or regional plus light GA, TXA for blood conservation (studied IV regimens centre on 1 g peri-incision per local protocol), multimodal opioid-sparing analgesia, early mobilisation, and VTE prophylaxis timed safely with neuraxial catheters.

Must cover.

• Preoperative optimisation and anaemia management
• Anaesthetic technique choice for THA/TKA
• TXA dosing principles and evidence base (1 g IV studied regimen; topical adjunct; optimum topical dose unknown) ^[2][7]
• Blood conservation bundle (cell salvage for selected revisions, restrictive thresholds, TXA)
• ERAS elements for joint replacement
• Regional analgesia strategies motor-sparing (adductor canal over femoral for early mobilisation)
• VTE prophylaxis interaction with neuraxial (ASRA agent-specific timing)
• PACU discharge and day-case arthroplasty readiness

Crisis. Unexpected massive bleeding or BCIS during cemented THA — older co-pathology patients carry higher BCIS likelihood; uncemented selection, pre-cement optimisation, and invasive monitoring in high-risk cases.

High-yield numbers/facts. Include exact taught figures where relevant (studied TXA 1 g IV regimen per the local protocol; Donaldson BCIS features and management at cementation; ASRA anticoagulant principles without inventing unverified hour intervals).^[4][5][7]