Experimental Production of Vascular Hypotension, and Bone Marrow and Fat Embolism with Methylmethacrylate Cement

Breed, Alan L.

doi:10.1097/00003086-197407000-00027

Cited by 91 publications

(37 citation statements)

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“…The authors only observed a fall in arterial blood pressure of 13%, which contrasts with a drop of almost 50% in our study. Breed (1974) pressurized the distal femur of rabbits with PMMA and bone wax and observed a fall in blood pressure in both groups within the first few seconds after starting the injection. Breed concluded that the cardiovascular disturbance observed in his study could not be fully explained by an adverse effect of the bone cement alone.…”

Section: Discussionmentioning

confidence: 98%

“…It has been suggested that the monomer causes systemic vasodilatation (Peebles et al 1972, Berman et al 1974, Samii et al 1980. However, the currently accepted mechanism is the microembolisation of the arterioles and capillaries in the lungs due to the extravasation of bone marrow particles, leading to cardiovascular deterioration (Breed 1974, Orsini et al 1987, Wheelwright et al 1993, Schemitsch et al 1998, Aebli et al 2002. Other explanations have included a nerve reflex triggered by the increase in pressure within the bone marrow cavity during manipulations (i.e.…”

mentioning

confidence: 99%

“…In the past, different animal models have been used to investigate FE (Breed 1974, Rudigier and Ritter 1983, Orsini et al 1987, Wheelwright et al 1993, Schemitsch et al 1998. Recently, an animal model of vertebroplasty has been developed to investigate FE (Aebli et al 2002).…”

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confidence: 99%

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Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

et al. 2005

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Background Fat embolism (FE), the release of bone marrow contents into the circulation and the subsequent cardiovascular changes, is still a potentially fatal complication during orthopedic surgery. Different causative factors have been suggested, but the exact pathomechanism of FE still remains unclear. We investigated the role of polymethylmethacrylate (PMMA) in FE during vertebroplasty in sheep.Methods In 8 sheep, two vertebral bodies were augmented alternatively with PMMA or bone wax. Pulmonary and cardiovascular parameters were monitored during the procedure.Results The peak response was similar for both groups and characterized by hypotension, a drop in cardiac output and pulmonary hypertension. However, the recovery in pulmonary arterial pressure and pulmonary vascular resistance was quicker in the wax group.Interpretation The injection of PMMA may cause prolonged pulmonary hypertension during vertebroplasty and also arthroplasty. Surgeons should be aware of this potential cardiovascular complication, especially in patients with impaired pulmonary and cardiovascular function.

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Section: Discussionmentioning

confidence: 98%

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confidence: 99%

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Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

et al. 2005

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“…This seems to be the decisive pathogenic factor for development of fat and bone marrow embolism [16,36,41]. Furthermore, with the use of conventional cementing techniques, the intramedullary pressures are raised further and the major component of cement, polymethylmethacrylate, has been implicated in producing a hypercoagulable state local to the site of the operation and systemically through marrow embolization of tissue thromboplastin into the veins [16,67,70].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Patel

Stygall

Harrington

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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BackgroundIntraoperative cerebral microembolization occurs in a substantial proportion of patients undergoing THA. Historically, postoperative cognitive dysfunction has been attributed to different factors, including anesthesia, but the influence of the surgery has not been thoroughly examined. Questions/purposes We conducted a prospective, controlled clinical trial to assess intraoperative cerebral microembolization during THA and neuropsychologic outcome. Methods The presence of a patent foramen ovale (PFO) also was investigated, using transcranial Doppler, to determine whether this affected cerebral microembolic incidence and load and whether microemboli occurred as a result of specific surgical activity. Forty-five patients were recruited who underwent THA and neuropsychologic assessment; a battery of tests was administered preoperatively and at 6 weeks and 6 months postoperatively. Results Overall, patients showed improvement in total neuropsychologic change scores at both postoperative intervals. The incidence of cerebral microembolization for THA was 23%. The prevalence of PFO was 37%. PFO did not appear to influence microemboli load or incidence. More microemboli were seen during femoral component insertion and impaction. Conclusions Intraoperative cerebral microembolization occurs in a substantial proportion of patients during THA recorded by transcranial Doppler. The microemboli load is low and is not influenced by the presence of PFO. Certain surgical activities seem responsible for greater cerebral microemboli generation. However, neuropsychologic outcome was not affected postoperatively by microemboli or other operative or patient variables.

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“…Several mechanisms have been proposed to account for this effect. [6][7][8] Epidural anaesthesia has been used safely for management of pheochromocytoma. 9-10 The technique permits a final assessment of sympathetic blockage prior to surgery.…”

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confidence: 99%

Perioperative management of a patient with a malignant pheochromocytoma

Miller

Robblee

1985

Can Anaesth Soc J

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Experimental Production of Vascular Hypotension, and Bone Marrow and Fat Embolism with Methylmethacrylate Cement

Cited by 91 publications

References 0 publications

Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

Polymethylmethacrylate causes prolonged pulmo-nary hypertension during fat embolism: A study in sheep

Cerebral Microembolization during Primary Total Hip Arthroplasty and Neuropsychologic Outcome: A Pilot Study

Perioperative management of a patient with a malignant pheochromocytoma

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