We examined the effect of methylmethacrylate cement on venous embolization and cardiac function in 20 patients having total hip arthroplasty under general anesthesia. Segmental wall motion abnormalities and intracardiac targets (presumably emboli) were investigated by making videotaped recordings of the transgastric short axis and longitudinal 4-chamber views of the heart with transesophageal echocardiography at different points during surgery. The incidence of segmental wall motion abnormalities was the most frequent during insertion of cemented femoral prostheses (8 of 14 patients had wall motion abnormalities). This was significantly different from baseline measurements taken at the beginning of surgery (P < 0.05). In addition, there were also significantly more segmental wall motion abnormalities in patients having a cemented femoral component compared to those having an uncemented femoral prosthesis (P < 0.05). The incidence of wall motion abnormalities during acetabular and femoral reaming and during wound closure was not significantly different from baseline. Intracardiac targets (emboli) were seen in all 20 patients during surgery. The largest number of emboli occurred during reaming of the femur and during insertion of the femoral prosthesis. Significantly more emboli were seen with cemented components (P < 0.02). Most emboli were small (< 2 mm) and appeared similar to the microbubbles produced by agitating saline with a small amount of air. Six patients also had larger (> 5 mm) emboli that appeared to be solid material. One patent foramen ovale was detected (5% incidence). There were no adverse cardiac or neurologic events, and heart rate and arterial blood pressure remained within normal limits throughout surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
"uration when nail insertion was com - bined with cementation . The benefits of cement are that it gives additional strength ( Harrington et al . 1976 , Harrington 1997 ) in femora with wide - spread disease or large lytic lesions . The harmful effects of methylmethacrylate are well document - ed in the literature ( Ware et al . 1991 , Pinto 1993 , Propst et al . 1993 , Fujimura et al . 1995 ) . The important effect of cement may be to seal the fem - oral shaft and increase intramedullary pressure more during pressurization and nail or prosthesis insertion than is usually encountered ( Pietak et al . 1997 ) ."
[Show abstract][Hide abstract] ABSTRACT: Intramedullary nail fixation is a common treatment for metastatic tumors of the femur with overt or impending femoral fracture. This procedure sometimes causes severe cardiorespiratory and vascular dysfunction. The clinical relevance of this is not dear. We reviewed 45 operations in 43 patients, where intramedullary nail fixation was used to treat metastatic femoral fractures and impending fractures. We studied the incidence of intraoperative oxygen desaturation and hypotension associated with intramedullary manipulation as markers of cardiorespiratory and vascular dysfunction. Acute oxygen desaturation and hypotension occurred in 11 of our 45 patients. Of these, 3 died, 2 required intensive care postoperatively and 6 made uneventful recoveries. We hope to highlight a serious complication in this patient group.
[Show abstract][Hide abstract] ABSTRACT: Patients with coronary artery disease are particularly at risk perioperatively, as myocardial infaretion, unstable angina, severe arrhythmia and cardiae death may occur. These events are often preceded by prolonged silent myocardial isehaemia (MI). Moreover, perioperative MI predicts long-term adverse cardiae outeome. Therefore, lt ls logical to prevent and treat MI. However, the detection of perioperative MI is difficult beeause of low sensitivity of ST-segment monitoring, low specificity of echocardiography and insuffident availability of equipment for its monitoring. A pragmatie approach is described, including preoperative consideration of myocardial revascularization prior to non-cardiae surgery and perioperative administration of antianginal agents; the effects of clonidine are discussed as weil. The role of anaesthetic techniques and normovolaemie haemodilution is eonsidered. MI episodes may be prevented or their duration may be shortened by treating tachycardia, hypotension and, possibly, hypertension. The risks of MI are particularly high during the postoperative period because increased global oxygen consumption associated with recovery, ventilator weaning, shivering and pain May lead to tachycardia and increased ventricular load. These fadors must be taken into account in order to prevent MI and improve postoperative cardiae outcome.
Annales francaises d'anesthesie et de reanimation 01/1995; 14(2):176–197. DOI:10.1016/S0750-7658(95)70017-X · 0.84 Impact Factor
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