Pulmonary and Circulatory Reactions During Total Hip Replacement Surgery

Abstract

The pulmonary and circulatory reactions to insertion of the acetabular and of the femoral prosthesis were studied during total hip replacement surgery in 22 patients with osteoarthrosis. The patients were given lumbar epidural analgesia and were divided into two groups. One group of 15 awake patients breathed air spontaneously (group A). The other group of seven patinets received additional anaesthesia with controlled ventilation with air (group B). This permitted an evaluation of the influence of the ventilatory pattern on the pulmonary and circulatory reactions to the surgical events. The greatest alterations were observed following impaction of the femoral prosthesis. This event caused the following statistically significant changes in both groups: An increase in total pulmonary venous admixture (from a mean value of 6.8 to 12.2% in group A and from 8.2 to 10.5% in group B) and a decrease in arterial oxygen tension (group A: 80.3 to 71.5 mmHg; group B: 82.6 to 76.9 mmHg); an increase in pulmonary vascular resistance (group A: 122 to 155 dyn -s- cm-5; group B: 129 to 164 dyn -s- cm-5) and an increase in mean pulmonary arterial pressure (group A: 17.3 to 19.0 mmHg; group B: 21.8 to 24.4 mmHg). Furtheremore, within the first 2 min after impaction a distinct transient rise in mean pulmonary arterial pressure by 2-4 mmHg was noted in a few patients, and in many patients the mean systemic arterial pressure decreased by 5 mmHg or more. No significant changes were found in cardiac output, pulmonary capillary wedge pressure, oxygen uptake, mixed venous oxygen tension, acid-base values, ratio of total dead space to tidal volume, or total airway resistance. The above findings indicate a tendency to pulmonary vascular and peripheral airway constriction leading to transient ventilation/perfusion disturbances and a decrease in arterial oxygen tension, and peripheral vasodilatation leading to a transient decrease in systemic arterial pressure.

Large Airway Response to Cemented Arthroplasty: Relationship to Hypoxaemia. An Experimental Study in Dogs

“…The hemodynamic and blood-gas abnormalities noted in the PT~-NL and PTi-NL groups (Fig. 3 , 4 and Table 1) are similar to those reported in humans (1,2,4,5 ) . The decreases of PTe and PTi after cement and again after prosthesis insertion in all three groups indicate that large airway smooth muscle relaxes in response to these maneuvers, at least in this animal model.…”

Pressurization of Vertebral Bodies During Vertebroplasty Causes Cardiovascular Complications

“…The likely cause for these changes was ventilation-perfusion mismatching and pulmonary shunting, caused by fat microembolization of the pulmonary vessels. 26,34,45 Alternatively or additionally, hypoxemia and hypercapnia may result from reflexive pulmonary vasoconstriction due to microembolization. 46,47 The reason there was no significant change in the wax group for the blood gas values is unclear.…”

“…Other investigators have also implicated peripheral vasodilation as the primary cause for a decrease in MABP during joint arthroplasty. 22,26 Originally, vasodilation, and thus fall in MABP, during joint arthroplasty was attributed to the vasoactive properties of the methylmethacrylate monomer. 6,8,27 However, the circulatory level of monomer required to induce systemic vasodilatation is several times greater than that reported during arthroplasty.…”

Perioperative Pulmonary Circulatory Changes During Bilateral Total Hip Arthroplasty Under Regional Anesthesia

“…The argument could be made that our findings of prolonged hemodynamic changes may at least in part reflect delayed effects of the first arthroplasty. However, anecdotal evidence from clinical experience and observations from previous studies suggest that pulmonary hemodynamic changes in response to unilateral procedures are small and transient 12–14. While conceptually results from a unilateral THA cohort would be interesting, performing pulmonary catheterization in healthy, elective unilateral hip arthroplasty recipients may further pose ethical limitations.…”