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Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients
Mehran Soleimanha1, Abbas Sedighinejad1, Mohammad Haghighi1
1Mehran Soleimanha MD, Ahmad Reza Mirbolook MD, Mohsen Mardani-Kivi MD, Department of Orthopedics, Guilan University of Medical Science, Rasht, Iran.
Insights
Cemented hip hemiarthroplasty in elderly patients can cause temporary cardiovascular changes, including blood pressure drops and arrhythmias. However, with anesthesiology care, the procedure is safe for femoral neck fractures.
Area of Science:
- Orthopedic Surgery
- Anesthesiology
- Cardiovascular Physiology
Background:
- Bone cement implantation syndrome (BCIS) is a significant intraoperative risk during cemented hip hemiarthroplasty.
- Elderly patients with femoral neck fractures are particularly susceptible to BCIS.
Purpose of the Study:
- To evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients.
- To assess the safety of this procedure in the context of BCIS.
Main Methods:
- Seventy-two elderly patients with femoral neck fractures underwent cemented hip hemiarthroplasty.
- Cardiovascular parameters including mean arterial pressure (MAP), systolic and diastolic blood pressure (SBP & DBP), arterial blood gas (ABG), and heart rate were monitored.
- Monitoring occurred at multiple time points: pre-cementation, immediately after, 5 and 10 minutes after, and at the end of surgery.
Main Results:
- A significant drop in MAP, SBP, and DBP was observed immediately after cementation.
- Arterial blood gas analysis showed a significant decrease in pH and base excess, with no change in O2 saturation.
- While 12 patients experienced arrhythmias, no cardiac arrest occurred, and no bradycardia was noted.
Conclusions:
- Cemented hip hemiarthroplasty is a safe procedure for elderly patients with femoral neck fractures, even those with osteoporosis.
- Strict anesthesiology monitoring is crucial for managing potential cardiopulmonary compromise during the procedure.
Background:
Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients.
Methods:
Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0th), 5 min (5th) and 10 min (10th) after cementation, and at the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated.
Results:
Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (P<0.001) with no changes in O2 saturation. Mean heart rate rose until the 5th and then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed.
Conclusions:
Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise.
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