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Minerva Anestesiologica 2002 June;68(6):537-47


language: Italian

Hemodynamic and respiratory changes during hip and knee arthroplasty. An echocardiographic study

Dambrosio M., Tullo L., Moretti B. **, Patella V. **, Simone C. **, Calò M. N. *, Dalfino L. *, Cinnella G.

Università degli Studi - Foggia Cattedra di Anestesia e Rianimazione Università degli Studi - Bari *Dipartimento Emergenza e Trapianti di Organi Sezione di Anestesia e Rianimazione **Dipartimento di Metodologia Clinica e Tecnologie Medico-Chirurgiche Sezione Ortopedia e Traumatologia

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Back­ground. The “­bone ­cement implan­ta­tion syn­drome” is a ­rare but ­severe com­pli­ca­tion ­observed espe­cial­ly dur­ing the inser­tion of cement­ed pros­the­ses in hip and ­knee replace­ment sur­gery. Sev­er­al mech­a­nisms are ­involved: ­effects of meth­yl­me­thac­ri­late, embo­lism of fat, air and ­bone mar­row, and ­release of tis­sue throm­bo­plas­tin dur­ing ace­tab­u­lar and femo­ral ream­ing. Aim of ­this ­study was to ­detect embol­ic ­events, ­right ­heart impair­ment, he­mod­y­nam­ic and res­pir­a­to­ry chang­es dur­ing hip and ­knee replace­ment sur­gery.
Meth­ods. ­Design: Pros­pec­tive ­study, ­between Feb­ru­ary-May 2001. Envi­ron­ment: Ortho­pe­dic Oper­a­tive ­room. ­Patients: Twen­ty-one ­patients who under­went ­total hip or ­knee arthro­plas­ty ­under gen­er­al anes­the­sia. ­Patients ­were divid­ed in meth­yl­me­thac­ry­late cement­ed pros­the­ses ­groups (CEM, n=10) and total­ly unce­ment­ed pros­the­ses (NON CEM, n=11). ­Data col­lec­tion: Stan­dard anes­the­sia mon­i­tor­ing and omni­plane TEE ­were per­formed. TEE ­probe was posi­tioned in ­order to ­obtain “­inflow-out­flow” ­views of ­right ­heart. Meas­ure­ments ­were ­obtained ­after anes­the­sia induc­tion (T1), during femoral realing (T2) at pros­the­ses inser­tion (T3), and at the end of sur­gery (T4).
­Results. Hemo­dy­nam­ic and res­pir­a­to­ry param­e­ters meas­ured in dif­fer­ent phas­es of sur­gi­cal pro­ce­dures ­were not dif­fer­ent with­in ­groups and ­between ­groups. Four­theen ­patients had TEE evi­dence of embo­li, and the phe­nom­e­non was ­more evi­dent in CEM ­group (Z= -347; p<0.001). Dur­ing pros­the­ses inser­tion, a ­slight, not sig­nif­i­cant ­increase in ­right ven­tric­u­lar dimen­sions was ­observed in ­both ­groups, with­out any ­right ven­tric­u­lar ­wall kinet­ic abnor­mal­ity. No dif­fer­ence was ­observed ­between ­groups. No ­adverse car­diac or cereb­ro­vas­cu­lar ­events in ­intra- and post­op­er­ato­ry peri­od ­were ­observed.
Con­clu­sions. In nor­mal ­patients ­total hip or ­knee arthro­plas­ty is asso­ciat­ed ­with embol­ic phe­nom­e­na, with­out any sig­nif­i­cant ­change in system­ic and ­right ­heart hemo­dy­nam­ics. Inser­tion of cement­ed pros­the­ses ­does not mod­i­fy hemo­dy­nam­ic pro­file. It ­remains to be elu­ci­dat­ed if the occur­rence of embo­li has a crit­i­cal ­role in ­patients ­with car­di­o­res­pir­a­to­ry dis­ease.

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