• M Kotyra, E Houltz, and S-E Ricksten.
• Department of Anaesthesia, Sahlgrenska University Hospital/Mölndal, Göteborg, Sweden.
• Acta Anaesthesiol Scand. 2010 Nov 1;54(10):1210-6.

BackgroundBone 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.MethodsFifteen 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.ResultsAfter 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.ConclusionsCemented hemiarthroplasty in patients with femoral neck fracture causes a pronounced pulmonary vasoconstriction and an impairment of RV function accompanied by pulmonary ventilation/perfusion abnormalities.© 2010 The Authors. Journal compilation © 2010 The Acta Anaesthesiologica Scandinavica Foundation.

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