Cardiovascular collapse associated with the use of methylmethacrylate

Methylmethacrylate has been used extensively in the United States since 1971 for the fixation of orthopedic prostheses. A chemical compound that generates a considerable amount of heat as it sets and hardens, it has been known to cause mild to moderate hypotension as well as cardiovascular collapse and death in some instances. Some of the purported etiologies of the untoward effects of methylmethacrylate include fat embolism, air embolism, bone marrow embolism, peripheral vasodilation, activation within the lungs of the clotting cascade, direct cardiovascular depressant effects of methylmethacrylate cement or monomer, and others. In this article, the use of methylmethacrylate in orthopedic procedures is reviewed, along with a discussion of some of the previously hypothesized causes of its side effects. Then a case report of its use in a 59-year-old woman with a pathological fracture of her left femur is presented. Finally, the implications for the anesthetist are noted, and suggested interventions to limit untoward effects with the use of methylmethacrylate are presented.