We measured the changes during operation in seven markers of coagulation in a prospective series of 84 @entity1 with @entity174 of the tibia or femur who were undergoing reamed intramedullary nailing. All @entity1 were also continually monitored using transoesophageal echocardiography to assess @entity236 . In a subset of 40 @entity1 , intraoperative cardiopulmonary function was monitored, using pulmonary and systemic arterial catheterisation. The procedure produced a significant increase in prothrombin time, activated partial thromboplastin time, the level of prothrombin fragments @entity6343 and D-dimers, and a decrease in the @entity2002 level, suggesting activation of both the coagulation and fibrinolytic pathways. There was evidence of both platelet hyper-reactivity and depletion, as estimated by an increase in @entity4938 levels and a decrease in the platelet count. In the @entity1 who had invasive monitoring there was an incremental increase in mean pulmonary arterial pressure, with the changes being greatest during insertion of the guide-wire and reaming. The change in markers of coagulation, pulmonary artery pressure and arterial @entity26 partial pressures correlated with the intraoperative @entity887 response. Greater changes in these parameters were observed during stabilisation of @entity174 and in those @entity1 in whom surgery had been delayed for more than 48 hours. Seven @entity1 with @entity174 developed more severe @entity519 episodes during reaming, which were associated with significantly greater arterial hypoxaemia, a fall in the right ventricular ejection fraction and an increase in the mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure and the pulmonary vascular resistance index. These changes suggested that the @entity1 had transient intraoperative right heart strain. Eight @entity1 developed significant postoperative respiratory compromise. They all had severe intraoperative @entity887 responses and, in the three who had invasive monitoring, there was a significantly greater increase in pulmonary artery pressure and alveolar-arterial @entity26 gradient, and a fall in the ratio of arterial partial pressure of @entity26 to the inspired @entity26 concentration. Operative delay, @entity954 and the scores for the severity of the coagulative and @entity887 responses were predictive of the development of @entity260 on univariate logistic regression analysis. On multivariate analysis, however, only the @entity887 and coagulative scores were significant independent predictors of @entity1576 .

The coagulative and cardiorespiratory responses to reamed intramedullary nailing of XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity2002 :: ('2244', 'Gene') :: ['fibrinogen'] @entity174 :: ('MESH:D050723', 'Disease') :: ['fractures', 'pathological fractures'] @entity26 :: ('MESH:D010100', 'Chemical') :: ['oxygen'] @entity6343 :: ('2161', 'Gene') :: ['F1+2'] @entity260 :: ('MESH:D011183', 'Disease') :: ['postoperative respiratory complications'] @entity887 :: ('MESH:D004617', 'Disease') :: ['embolic'] @entity519 :: ('MESH:D000860', 'Disease') :: ['hypoxic'] @entity1576 :: ('MESH:D012131', 'Disease') :: ['respiratory complications'] @entity954 :: ('MESH:D016063', 'Disease') :: ['intraoperative paradoxical embolisation'] @entity236 :: ('MESH:D001855', 'Disease') :: ['marrow embolism'] @entity4938 :: ('5473', 'Gene') :: ['beta-thromboglobulin']
@entity174 :: (MESH:D050723,Disease) :: ['isolated fractures']
