Anesthetic management and safety for patients at risk of bone cement implantation syndrome

An Essay submitted for partial fulfillment of Master Degree in Anesthesia

By
Dina Samy Elsaid
M.B., B.Ch. (2006) Ain Shams University

Supervised By

Prof. Dr / Amir Ibrahim Salah

Professor of Anesthesia and intensive care Faculty of Medicine, Ain Shams University

Dr / Waleed Abd Al-Mageed Mohamad Al-Taher

Assistant Professor of Anesthesia and Intensive care Faculty of Medicine , Ain Shams University

Dr / Hala Salah El-Din El-Ozairy

Lecturer of Anesthesia and Intensive care. Faculty of medicine, Ain Shams University
Faculty of Medicine Ain Shams University 2010

Introduction
Bone cement implantation syndrome (BCIS) has no agreed definition; it is characterized by a number of clinical features that may include hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance (PVR), and cardiac arrest. It is most commonly associated with, but is not restricted to, hip arthroplasty. It usually occurs at one of the five stages in the surgical procedure; femoral reaming, acetabular or femoral cement implantation, insertion of the prosthesis or joint reduction, (Werner., 2003). There are many theories focused on the release into the circulation of MMA cement monomer during cementation. More recent research has investigated the role of emboli formed during cementing and prosthesis insertion. Several mechanisms such as histamine release, complement activation, and endogenous cannabinoid-mediated vasodilatation have also been proposed ,(Motobe, et al. , 2004). Numerous patient-related risk factors have been implicated in the genesis of BCIS including old age, poor preexisting physical reserve, impaired cardiopulmonary function, pre-existing pulmonary hypertension, osteoporosis, bony metastases, and concomitant hip fractures, particularly pathological or intertrochanteric fractures, ( Herrenbruck , et al., 2002). The anesthetic technique should be tailored to the individual patient and the type of prosthesis. Although there is no clear evidence regarding the impact of anesthetic technique on the severity of BCIS, an animal study has suggested that volatile anesthetic agents may be associated with a greater hemodynamic change for the same embolic load ,( Guest ,et al ., 1995). A high level of hemodynamic monitoring should be considered in high risk patients such as Central venous pressure (CVP) and the use of an intraoperative pulmonary artery catheter or transoesophageal echocardiography has been suggested in high risk patients ,( Parvizi ,et al ., 1999).

Aim of the Work

The aim of this work is to discuss the bone cement implantation syndrome and the Anesthetic safety through its applications and proper management to decrease its risk.

Contents
1. 2. 3. 4. Introduction. Aim of the work. Bone cement implantation syndrome. Anesthetic management and safety for patients at risk of bone cement implantation syndrome. 5. 6. 7. Summary. Arabic summary. References.

References
1. Guest CB, Byrick RJ, Mazer CD, et al (1995): Choice of anesthetic regimen influences haemodynamic response to cemented arthroplasty. Can J Anesth ; 42: 92836 2. Herrenbruck T, Erickson EW, Damron TA, et al (2002): Adverse clinical events during cemented long-stem femoral arthroplasty. Clin Orthop Relat Res ; 395: 15463

3. Motobe T, Hashiguchi T, Uchimura T, et al (2004): Endogenous

cannabinoids are candidates for lipid mediators of bone cement implantation syndrome. Shock ; 21: 812 4. Parvizi J, Holliday AD, Ereth MH, et al (1999): Sudden death during primary hip arthroplasty. Clin Orthop Relat Res ; 369: 3948 5. Werner L (2003): A response to Sudden deaths during hip hemiarthroplasty. Anesthesia ; 58: 9223 .