Segmental wall motion abnormalities in patients undergoing total hip replacement: correlations with intraoperative events.
ABSTRACT 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)
[Show abstract] [Hide abstract]
ABSTRACT: Bone cement implantation syndrome (BCIS) is characterised by hypoxia, hypotension and loss of consciousness occurring early after bone cementation. The haemodynamic perturbations during BCIS have not been extensively studied, particularly not in patients with femoral neck fracture. We evaluated the effects of cemented hemiarthroplasty, in these patients, on pulmonary haemodynamics, right ventricular performance, intrapulmonary shunting and physiological dead space. Fifteen patients undergoing cemented hemiarthroplasty because of femoral neck fracture were included. Surgery was performed under total intravenous anaesthesia in the lateral position. All patients were catheterised with a radial and pulmonary artery catheter, for continuous measurements of mean arterial pressure (MAP), pulmonary arterial pressure (PAP), cardiac output, mixed venous oxygen saturation, right ventricular end-diastolic volume (RVEDV) and right ventricular ejection fraction (RVEF). Haemodynamic measurements and blood gas analyses were performed after induction of anaesthesia, during surgical stimulation before and immediately after bone cementation and prosthesis insertion, 10 and 20 min after insertion and during skin closure. After bone cementation and prosthesis insertion, MAP (-10%), cardiac index (-10%) and stroke volume index (-10%) decreased, while PAPs (10-15%) and the pulmonary vascular resistance index (45%) increased. RVEF decreased by 10-20%, while the RVEDV index increased by 10%. Pulmonary haemodynamic and RV variables changed progressively with time, while intra-pulmonary shunting and physiological dead space increased immediately after prosthesis insertion and then returned to baseline. Cemented hemiarthroplasty in patients with femoral neck fracture causes a pronounced pulmonary vasoconstriction and an impairment of RV function accompanied by pulmonary ventilation/perfusion abnormalities.Acta Anaesthesiologica Scandinavica 11/2010; 54(10):1210-6. DOI:10.1111/j.1399-6576.2010.02314.x · 2.36 Impact Factor
Article: Ischémie myocardique et anesthésie[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 · 0.77 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: Venous air embolism (VAE) or fat embolism (FE) may occur in similar clinical settings such as after multiple injuries or total hip replacement. We designed this study to observe the differences between VAE and FE in routine intraoperative monitoring methods, transesophageal echocardiography (TEE), and fatal volume in pigs. Sixteen domestic pigs were randomly assigned to either a fat group (n = 8) or an air group (n = 8). Each animal was injected with a series of volumes of air or fat. TEE and routine intraoperative monitoring were used during the experiment. The echogenic pattern of air or fat emboli were recorded and was graded (grade 0, no emboli; grade 1, a few fine emboli; grade 2, embolic masses less than 5 mm in diameter and the right atrium opacified with echogenic materials; grade 3, fine emboli mixed with large embolic masses greater than 5 mm in diameter or serpentine emboli). Precordial auscultation was performed before and after each injection of air or fat. The fatal volumes of air and fat were recorded. No echogenic pattern grade 3 on TEE in the fat group was observed even fatal volume of fat was injected, whereas echogenic pattern grade 3 was found in all pigs in the air group when > or = 0.5 mg/kg of air was injected (0/8 vs. 8/8, p < 0.01). Paradoxical embolism and cutaneous petechiae was more common in the fat group than in the air group (8/8 vs. 1/8, 6/8 vs. 0/8, p < 0.05). "Bubble-like" sounds, "drum-like" murmurs, and "mill-wheel" murmurs were only heard in the air group but not in the fat group (8/8 vs. 0/8, p < 0.01). Fatal volume of air was much higher than that of fat (4 mL/kg +/- 0.76 mL/kg vs. 0.24 mL/kg +/- 0.05 mL/kg, p < 0.01). Large extensive echogenic masses on TEE, "bubble-like" sounds, "drum-like" murmurs, and "mill-wheel" murmurs were more likely associated with VAE. All of fat emboli were fine on TEE. Paradoxical embolism and cutaneous petechiae were more common in FE. Fatal volume of fat is lower than that of air.The Journal of trauma 08/2008; 65(2):416-23. DOI:10.1097/TA.0b013e3181589fcb · 2.35 Impact Factor