Endogenous Cannabinoids are Candidates for Lipid Mediators of Bone Cement Implantation Syndrome

Abstract

Acute hypotension, hypoxemia, cardiac arrhythmias, cardiac arrest, (or a combination of these), and sudden death are well-recognized complications of the cemented hip arthroplasty procedure. Collectively, these are known as the bone cement implantation syndrome (BCIS). The endogenous cannabinoids, anandamide (ANA) and 2-arachidonylglycerol (2-AG), are reported to be strong vasodilators and play a role in the hypotension associated with hemorrhagic and septic shock. In the present study, a potential role for the endogenous cannabinoids in influencing hemodynamic variables in BCIS was investigated. Thirty-five patients (35 hips) entered a prospective, randomized clinical trial. The patients were divided into two groups. Group 1 comprised 16 patients who had the component inserted using a conventional cementing technique, whereas group 2 consisted of 19 patients who had the femoral component inserted without cement. Blood samples were taken at six consecutive time points: before anesthesia, after reaming the femur, 2 min after insertion of stems with or without cement into the femur, and 10 min, 20, and 30 min after stem insertion. In group 1 (with cement), the mean levels of ANA and 2-AG significantly increased after stem insertion. In a comparison of each group after stem insertion, mean ANA and 2-AG levels in group 1 also significantly differed from those in group 2. By contrast, in group 2 (without cement) neither ANA nor 2-AG levels exhibited a significant increase or change at any point in time. In conclusion, we have shown for the first time that endogenous cannabinoids are candidates for lipid mediators of BCIS.

Interleukin-2 Suppression by 2-Arachidonyl Glycerol Is Mediated through Peroxisome Proliferator-Activated Receptor γ Independently of Cannabinoid Receptors 1 and 2

“…In activated splenocytes, suppression of IL-2 by 2-AG is induced at concentrations as low as 2.5 M, which is within an order of magnitude of the calculated endogenous 2-AG levels detected in human plasma (Motobe et al, 2004). It is noteworthy that the intracellular concentrations of structurally related congeners, such as anandamide, have been reported to exceed extracellular concentrations by as much as 3 orders of magnitude (Hillard and Jarrahian, 2003).…”

Rejyonel anestezi altında gelişen kemik sement implantasyon sendromu: Olgu sunumu

“…KSİS görülebilen diğer operasyonlar arasın-da diz protezi ve vertebraplasti operasyonları sayılabilir (3). Etyolojisi ve patofizyolojisi tam olarak anlaşılamamış-tır ancak metilmetakrilat (MMA) sement monomerlerinin sementasyonu takiben dolaşıma geçmesi, histamin deşarjı, kompleman aktivasyonu ve endojen kannabinoid ilişkili vazodilatasyon gibi mekanizmalar ortaya konulmuştur (4).…”

Intralipid treatment: Is it only the tip of an iceberg? A new suggestion: Bone cement implantation syndrome (BCIS)

“…By contrast, in group 2 (without cement) neither ANA nor 2-AG levels exhibited a significant increase or change at any point in time. In conclusion, it has been shown for the first time that endogenous cannabinoids are candidates for lipid mediators of BCIS [18].…”

“…The endogenous cannabinoids, anandamide (ANA) and 2-arachidonylglycerol (2-AG), are reported to be strong vasodilators and play a role in the hypotension associated with hemorrhagic and septic shock. In the present study [18], a potential role for the endogenous cannabinoids in influencing hemodynamic variables in BCIS was investigated. Thirty-five patients (35 hips) entered a prospective, randomized clinical trial.…”