Air aspirated from the venous system during total hip replacement

Abstract

SummaryIn order to Cardiac arrest has been reported in about 30 patients undergoing a hip replacement during which methylmethacrylate cement (RWS) was used. These complications supervened after the insertion of the femur prosthesis into the medullary cavity, which had been filled with acrylic cement. In most cases, however, the complications were of such a character, that the patients were left clinically unaffected. Charnley rcported only two fatal cardiac arrests in a series of 10 356 total hip replacements.2 During a total hip replacement, hypotension, hypoxaemia and hypercapnia are seem3 The respiratory dead space rises by some 257; and the lung compliance falls by 3G40 ml/kPa4 These complications may be caused by fat e m b~l i s m ,~,~ as fat emboli were found in the lungs of many of the dead patients. Modig3 has demonstrated the formation of fat emboli in the lungs, but has also shown that they are diminutive and of no importance. Moreover, it should be noted. that heart massage results in the

Air Embolism During Total Hip Replacement: Comparison of Two Surgical Techniques

“…Air embolism during total hip replacement surgery is potentially hazardous and may occasionally be fatal [1,2,13,14,16,18]. The manoeuvres that have been suggested to reduce the incidence of air embolism, such as venting the femoral shaft [5,14,16,17], have met with limited success -a soft suction catheter may collapse from pressure exerted by the inserted prosthesis, rendering it ineffectual. Vent holes drilled in the distal femoral shaft have also been described [17].…”

Air Embolism

“…According to the literature, gas embolism may occur in cardiac surgery, cardiology, critical care and pulmonology, diving and hyperbaric medicine, endoscopic and laparoscopic surgery, gastroenterology, nephrology, neurosurgery, obstetrics and gynecology, otolaryngology, orthopedics, urology, vascular surgery, etc. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Among these, air embolism occurs more frequently in neurosurgical and otolaryngological procedures when compared to surgical procedures in other specialties.…”

“…There are numerous surgical or other non-surgical invasive procedures where gas embolism has been reported as a complication: (1) needle biopsy of the lung (bronchoscopic or percutaneous), lung resection [15][16][17]24] and radiofrequency ablation of lung cancer [25], (2) arthroscopy and arthroplasty [18,26], (3) gynecological procedures (hysteroscopy [19,27,28], C-section [29]), (4) gastrointestinal procedures (laparoscopy [30], colonoscopy [21], endoscopic retrograde cholangiopancreatography (ERCP) [20]) and (5) cardiac procedures (heart surgeries performed with cardiopulmonary bypass [22], cardiac implantable electronic devices implantation [23,31], cardiac ablation procedures of cardiac arrhythmias) [32][33][34]. Gas embolism has also been described in ophthalmological [35] and dental procedures [36].…”

Verminderung von schweren kardialen Komplikationen w�hrend der Implantation von zementierten H�fttotalendoprothesen bei Oberschenkelhalsfrakturen

“…Die Genese dieser Komplikationen ist als multifaktoriell beschrieben und reicht von der Luftembolie [2,3,4,8,9] über die Fett-und Knochenmarksembolie [14,15,17,21,22] durch den Druckanstieg im Femurkanal bei Einbringen des Prothesenschafts [18,31,39] bis zur Freisetzung von Mediatoren, insbesondere von Histamin durch Methylmethacrylat (Palacos) [20,26,38,41].…”

“…Unsere eigenen Erfahrungen und Hinweise in der Literatur auf Luftembolien bei Implantation einer Hüfttotalen-doprothese mit Methylmethacrylat [3,4,8,10,11,16,18,19,25,36] Zur statistischen Analyse der wurde der χ 2 -Test auf einem Siginifikanzniveau von α=0,05 angewendet.…”