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Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report

INTRODUCTION: Bone Cement Implantation Syndrome (BCIS) is a lethal condition with complex physiological changes after the insertion of Methyl Methacrylate (MMA) cement during intraoperative arthroplasty. Despite the etiology and the pathophysiology of BCIS has not been fully understood, several mech...

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Autores principales: Dradjat, Respati Suryanto, Pradana, Ananto Satya, Putra, Domy Pradana, Hexa Pandiangan, Ray Asaf, Cendikiawan, Felix, Mustamsir, Edi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787938/
https://www.ncbi.nlm.nih.gov/pubmed/33388512
http://dx.doi.org/10.1016/j.ijscr.2020.12.076
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author Dradjat, Respati Suryanto
Pradana, Ananto Satya
Putra, Domy Pradana
Hexa Pandiangan, Ray Asaf
Cendikiawan, Felix
Mustamsir, Edi
author_facet Dradjat, Respati Suryanto
Pradana, Ananto Satya
Putra, Domy Pradana
Hexa Pandiangan, Ray Asaf
Cendikiawan, Felix
Mustamsir, Edi
author_sort Dradjat, Respati Suryanto
collection PubMed
description INTRODUCTION: Bone Cement Implantation Syndrome (BCIS) is a lethal condition with complex physiological changes after the insertion of Methyl Methacrylate (MMA) cement during intraoperative arthroplasty. Despite the etiology and the pathophysiology of BCIS has not been fully understood, several mechanisms have been discovered. Some clinical manifestations of BCIS are hypotension, hypoxemia, a decrease of consciousness, arrhythmia, pulmonary hypertension, and cardiac arrest. PRESENTATION OF CASE: A 67 years old woman underwent cemented hemiarthroplasty operation due to intertrochanteric fracture in her right femur. The hemodynamic was stable before and during operation, but suddenly the patient went into cardiac arrest as the cement inserted. Immediate resuscitation was performed successfully and stable hemodynamic was achieved. DISCUSSION: Several risk factors including underlying cardiovascular disease, advanced age, osteoporosis (enlarged porous cavities increase the risk of emboli generation), fracture type, metastatic bone disease, femoral canal diameter of more than 21 mm, previously non-instrumented femoral canal, and patent foramen ovale (paradoxical embolus). Some studies have shown usage of H1 and H2 antagonists, methylprednisolone, inotropes, vasopressor, and some alterations in surgical technique, can prevent the progression of the BCIS. Communication between the orthopaedic surgeon and anesthesiologist and high-quality cardiopulmonary resuscitation (CPR) will become a good basis in treating BCIS. CONCLUSION: Preoperative optimization by increasing oxygen inspiration concentration, usage of inotropes and vasopressor, and avoiding intravascular volume depletion during operation is essential in cemented arthroplasty procedure. Both orthopaedic surgeon and anesthesiologist should recognize the clinical presentation of BCIS and well-prepared for the management of BCIS including any supportive measures.
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spelling pubmed-77879382021-01-11 Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report Dradjat, Respati Suryanto Pradana, Ananto Satya Putra, Domy Pradana Hexa Pandiangan, Ray Asaf Cendikiawan, Felix Mustamsir, Edi Int J Surg Case Rep Case Report INTRODUCTION: Bone Cement Implantation Syndrome (BCIS) is a lethal condition with complex physiological changes after the insertion of Methyl Methacrylate (MMA) cement during intraoperative arthroplasty. Despite the etiology and the pathophysiology of BCIS has not been fully understood, several mechanisms have been discovered. Some clinical manifestations of BCIS are hypotension, hypoxemia, a decrease of consciousness, arrhythmia, pulmonary hypertension, and cardiac arrest. PRESENTATION OF CASE: A 67 years old woman underwent cemented hemiarthroplasty operation due to intertrochanteric fracture in her right femur. The hemodynamic was stable before and during operation, but suddenly the patient went into cardiac arrest as the cement inserted. Immediate resuscitation was performed successfully and stable hemodynamic was achieved. DISCUSSION: Several risk factors including underlying cardiovascular disease, advanced age, osteoporosis (enlarged porous cavities increase the risk of emboli generation), fracture type, metastatic bone disease, femoral canal diameter of more than 21 mm, previously non-instrumented femoral canal, and patent foramen ovale (paradoxical embolus). Some studies have shown usage of H1 and H2 antagonists, methylprednisolone, inotropes, vasopressor, and some alterations in surgical technique, can prevent the progression of the BCIS. Communication between the orthopaedic surgeon and anesthesiologist and high-quality cardiopulmonary resuscitation (CPR) will become a good basis in treating BCIS. CONCLUSION: Preoperative optimization by increasing oxygen inspiration concentration, usage of inotropes and vasopressor, and avoiding intravascular volume depletion during operation is essential in cemented arthroplasty procedure. Both orthopaedic surgeon and anesthesiologist should recognize the clinical presentation of BCIS and well-prepared for the management of BCIS including any supportive measures. Elsevier 2020-12-28 /pmc/articles/PMC7787938/ /pubmed/33388512 http://dx.doi.org/10.1016/j.ijscr.2020.12.076 Text en © 2020 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Dradjat, Respati Suryanto
Pradana, Ananto Satya
Putra, Domy Pradana
Hexa Pandiangan, Ray Asaf
Cendikiawan, Felix
Mustamsir, Edi
Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report
title Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report
title_full Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report
title_fullStr Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report
title_full_unstemmed Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report
title_short Successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: A case report
title_sort successful management of severe manifestation bone cemented implantation syndrome during hemiarthroplasty surgery in patient with multiple comorbidities: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787938/
https://www.ncbi.nlm.nih.gov/pubmed/33388512
http://dx.doi.org/10.1016/j.ijscr.2020.12.076
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