Understanding Bone Cement Implantation Syndrome

Bone cement implantation syndrome (BCIS) is a rare and potentially fatal perioperative complication of cemented bone surgery. Clinically, it can be as benign as transient desaturation or mild hypotension. In its more severe presentation, BCIS can cause serious cardiac dysrhythmias and cardiac arrest, and in cemented hemiarthroplasty for femoral neck fracture, BCIS may carry up to a 16-fold increase in 30-day postoperative mortality. The etiology and pathophysiology of BCIS are not fully established; however, results of studies and clinical reports are consistent, citing right ventricular failure secondary to increased pulmonary artery pressure as the cause of systemic hypotension and sudden cardiac arrest. The purpose of this article was to review the literature for a comprehensive understanding of bone cement and BCIS. This article reviews the history of bone cement and its associated hazards, etiology/ pathophysiology and clinical presentation of BCIS, preoperative assessment and planning for cemented procedures, anesthetic management of BCIS, and the surgeon's role in reducing the risk of BCIS.