Cardiovascular collapse after femoral prosthesis surgery for acute hip fracture

Abstract

Prosthetic revision of h,p fractures may result in embolization of tissue products leading to death. In thts report, from cases r'eported to the Anaesthesia Advisory Committee to the Chief Coroner of Ontario, emphasis is placed on the immediate resuscitative procedures which may offset a fatal outcome. Clinical features: Two elderly patients are reported in whom hip fractures necessitated primary prosthetic hip repair, The first patient, with a history of limited cardiac reserve and syncope, suffered a subcapital hip fracture. Under general anaesthesia, a Moore's prosthesis was inserted. The anaesthetic period remained relatively stable until surgical r-earning of the femoral canal. Bradycardia, hypotension and cyanosis developed and quickly proceeded to a fatal cardiac arrest. Autopsy demonstrated diffuse pulmonary embolism of fat and thrombus. The second patient suffered a fl-acture around the stem of a previously inserted femoral prosthesis. Under general anaesthesia, a new cemented hip prosthesis was inserted, following which hypotension occurred. This was supported with small doses of ephedrine, ventilation was controlled with oxygen and the procedure was quickly terminated. Despite addition of a dopamine infusion, cardiac arrest and death followed. Autopsy disclosed massive fat and bone marrow embolization.

Successful management of massive intraoperative pulmonary fat embolism with percutaneous cardiopulmonary support

“…[1011] Subsequent right ventricular dilatation may result in septal shift resulting in a decrease in left ventricular filling volume, leading to low CO. High right ventricular end-diastolic pressure in addition to low systemic blood pressure results in ischaemia of the right ventricle, potentiating the vicious cycle of right ventricular depression, dysfunction, and death. In our patient we kept cardiac massage going for an hour.…”

Rejyonel anestezi altında gelişen kemik sement implantasyon sendromu: Olgu sunumu

“…Rejyonel anestezi uygulanan hastalarda ise ilk belirtiler dispne ve algı değişiklikleridir (16). KSİS sırasında gelişen kardiyovasküler kollapsa sağ ventrikül yetmezliği olarak muamele edilmesi önerilmektedir.…”

Fat embolism and postoperative coagulopathy

“…4 Après révision, le Comité a souligné deux aspects cliniques importants. Premièrement, les patients qui présentent une réserve cardio-pulmonaire diminuée semblent plus à risque, ce qui devrait alors inciter les anesthésiologistes à prévoir la possibilité d'un arrêt cardiaque soudain.…”

“…4 After reviewing these cases, the Committee emphasized two clinically important points. Firstly, patients with limited cardiopulmonary reserve appear at highest risk, thus anesthesiologists should anticipate the possibility of sudden cardiac arrest.…”