• Tomoko Yamada, Katsuyuki Momwaki, Kazuhisa Shmroyama, Tomota Ohtani, Akihiko Sakai, Tomoaki Miki, and Masako Kobayashi.
• Department of Anesthesiology, Critical Care and Pain Medicine, National Hospital Organization Kure Medical Center.
• Masui. 2007 Jul 1;56(7):810-6.

BackgroundAnesthesia for patients who undergo surgery for femoral neck fractures can be associated with severe cardiopulmonary complications.MethodsWe retrospectively studied 361 consecutive patients who underwent surgery for femoral neck fractures. Dividing patients into three groups according to type of surgery-hip hemiarthroplasty (n=134), compression hip screw (n=123) or gamma nail (n=104)--we calculated the incidences of cardiorespiratory deterioration during anesthesia and examined factors associated with it.ResultsAmong hemiarthroplasty patients, six (4.5%) encountered cardiorespiratory deterioration; four (3.0%) experienced profound hypotension, bradycardia or cardiac arrest immediately after implantation of the bone cement or insertion of the prosthesis into the femoral bone; and two (1.5%) developed hypoxia and angina pectoris during the late phase of surgery. Patients who underwent compression hip screw or gamma nail had no cardiorespiratory deterioration. No difference was found in patient characteristics or type of anesthesia used among the three surgery groups. Time of surgery and amount of blood loss both were significantly greater in patients undergoing hemiarthroplasty.ConclusionsThe surgical techniques selected for hip hemiarthroplasty, which is associate with an increase in intramedullary pressure, may be a significant risk factor for cardiorespiratory deterioration from anesthesia in patients undergoing surgery for femoral neck fracture.

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