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Case Report Journal of Anaesthesia and Critical Care Case Reports 2015 July-Sep;1(1): 24-26
24 | Journal of Anaesthesia and Critical Care Case Reports | Volume 1 | Issue 1 | July-Sep 2015 | Page 24-26
Adhye B et al www.jaccr.com
monitor. Crystalloids and packed cell RBC's as 0.06% [5]. Transcranial and associated comorbidities, osteoporosis and
were infused rapidly. Suddenly patient transoesophageal doppler have showed that replacement secondary to fractures have
developed ventricular tachycardia which almost all cases with cemented femoral higher predisposition toward BCIS [6,7].
was promptly treated with DC shock of 200 prosthesis especially in hip arthroplasty Parvizi et al noted higher rate of
J from a biphasic defibrillator. Patient surgery will have embolic showers and cardiovascular complication in cases with
reverted back to sinus rhythm. BCIS. The severity maybe different and pathological fractures [5]. Our case was also
Hypotension persisted for which most of the patients escape with minor of pathological fracture secondary to
noradrenaline infusion was started. Right changes in blood pressure or oxygenation plasmacytoma. Tumors may cause
internal jugular venous cannulation was [3,4,6,7]. When full blown, mortality is secondary changes in vascular architecture
done. CVP was 20 cm of H2O. Left radial extremely high. leading to higher chances of vascular
artery cannulation was also done for Several cases and studies are reported on embolization [6]. Also in our case there was
invasive monitoring of BP. Arterial blood mortality in these cases. In 2004 a case was prexisting diastolic dysfunction. Thus our
gas analysis showed metabolic acidosis. This reported of a women who developed BCIS case had higher chance of BCIS. We could
was corrected with Inj sodabicarbonate while undergoing hemiarthroplasty for initiate appropriate resuscitative protocols
(8.4%) 50 ml. Patient started showing signs femoral neck fracture. She was resuscitated and the patient survived. Retrospectively,
of spontaneous respiratory efforts. Surgery but remained in a noresponsive comtose we thought that in such cases, we should
was finished. She was shifted to Intensive state. Serial magnetic resonance imaging have started with Intra-arterial BP
care unit and put on mechanical ventilation (MRI) scans showed multiple cerebral fat monitoring and a CVP line. The readiness
on SIMV with PS mode. Inotropes emboli [8]. to handle such complication appears to be
continued. After two hours patient started In another case of total hip arthroplasty the single most factor for a favourable
responding to deep painful stimuli. there was no event during surgery but outcome. Thus in cases where the risk
During this episode, urine output had patient developed severe BCIS after surgery. factors are identified, high index of
dropped. As CVP was still high inj MRI scans suggested cerebral fat emboli suspicion for intraoperative events should
frusemide 40 mg intravenously. Urine [9]. In India 4 cases were reported from one be maintained and the anaesthesia team
output improved after initial haematuria. centre out of which 3 survived and one died should be ready for such eventuality.
After 4 hours, there was spontaneous eye [10]. Another case was reported from Although current literature still does not
opening. She was transfused total 4 units of Andhra Pradesh, where despite initial have enough evidence to accurately
PCV and 3 Units of fresh frozen plasma. revival, patient succumbed after 8 hours calculate the risk and benefits in such cases
Noradrenaline was stopped after 4 hours postoperative [11]. An interesting case was [13] we should be aware of the eventuality
and blood pressure was maintained without reported where Bone Cement Implantation and be prepared for the same.
any support. Low dose Epidural infusion Syndrome occurred during spinal surgery
was started with bupivacaine 0.1 % at the with cement augmented screw fixation Clinical Message
rate of 5ml/hour. After 8 hours, patient requiring cardiac surgery for removal of The whole purpose of this Case report was
started obeying commands. Six hours later emboli from pulmonary artery [12]. The to make everybody aware that this can
she was fully conscious and was extubated patient survived in this case. A recent report actually happen in patients with any of the
after a short trial of CPAP and T-piece. from National Health Services (NHS) UK, risk factors. We are going to see more and
Patient had complete amnesia of the whole reported 62 cases, of which 41 (66%) died. more comorbid cases coming for cemented
episode. Further course in the hospital was Thus the casualty rates are quite high once surgeries, apart from Total Hip
uneventful. patient develops BCIS [13] although at Replacements. Proper understanding of the
times patient do survive and have good syndrome, early recognition and prompt
Discussion recovery. What determines these outcomes management as per the standard
The incidence of BCIS is quite rare. is still unclear but clinical expertise and resuscitation protocols will improve survival
Intraoperative mortality secondary to preparedness of the anaesthesia team and in such life threatening complication.
cardiopulmonary changes during cemented also patient factors that predisposed to
arthroplasty is quoted to be 0.02% to 6.6% BCIS play a definite role.
[3,4]. Parvizi et al reported the incidence of Various predisposing factors are implicated
intraoperative deaths during arthroplasties with high incidence of BCIS. Advanced age,
References
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