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Delayed hypoxemia after bone cement insertion during total hip replacement under spinal anesthesia--a case report.
Chian-Lang Hong1, Hung-Pin Liu, Chung-Yuan Wu
1Department of Anesthesia, Chang Gung Memorial Hospital at Chia Yi, No. 6, Sec West, Chia Pu Road, Putz City, Chia Yi, Taiwan, R.O.C.
Acta Anaesthesiologica Sinica
|May 16, 2003
Summary
Delayed hypoxemia occurred in a healthy male patient two hours after total hip replacement surgery. This case highlights the potential for serious pulmonary complications following bone cement application.
Area of Science:
- Anesthesiology
- Pulmonary Medicine
- Orthopedic Surgery
Background:
- Total hip replacement (THR) surgery involves the use of bone cement.
- Spinal anesthesia is commonly used for THR procedures.
- Postoperative pulmonary complications can occur, though typically not delayed.
Observation:
- A healthy male patient developed progressive tachypnea and bilateral wheezing two hours after THR surgery.
- The patient experienced hypoxemia (low PaO2) and decreased oxygen saturation despite supplemental oxygen.
- Bronchodilator therapy provided temporary relief for bronchospasm but not persistent hypoxemia.
Findings:
- Ventilation-perfusion lung scan indicated multiple pulmonary emboli as the cause of delayed hypoxemia.
- Bone cement embolization is a potential, albeit rare, complication following THR.
Implications:
- This case underscores the importance of considering delayed pulmonary complications after THR, even in healthy patients.
- Pulmonary embolism secondary to bone cement should be included in the differential diagnosis for postoperative hypoxemia.
- Further investigation into the mechanisms and prevention of bone cement pulmonary embolism is warranted.