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Intraoperative cerebral arterial embolization during total hip arthroplasty

Fat embolism to the pulmonary circulation is known to occur during total hip arthroplasty, especially during insertion of a cemented femoral component. Fat and air bubbles may enter the systemic circulation via a patent foramen ovale or through pulmonary circulation. To determine whether microemboli...

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Published in:	Anesthesiology (Philadelphia) 2000-08, Vol.93 (2), p.315-318
Main Authors:	EDMONDS, C. R, BARBUT, D, HAGER, D, SHARROCK, N. E
Format:	Article
Language:	English
Subjects:	Adult Aged Arthroplasty, Replacement, Hip Biological and medical sciences Cognition Disorders - etiology Comorbidity Embolism, Fat - complications Embolism, Fat - diagnostic imaging Female Humans Intraoperative Complications Male Medical sciences Middle Aged Middle Cerebral Artery - diagnostic imaging Orthopedic surgery Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Ultrasonography, Doppler, Transcranial
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creator	EDMONDS, C. R BARBUT, D HAGER, D SHARROCK, N. E
description	Fat embolism to the pulmonary circulation is known to occur during total hip arthroplasty, especially during insertion of a cemented femoral component. Fat and air bubbles may enter the systemic circulation via a patent foramen ovale or through pulmonary circulation. To determine whether microemboli to the brain were occurring during total hip arthroplasty, 23 patients underwent transcranial Doppler assessment of emboli to the middle cerebral artery during total hip arthroplasty. Surgery was performed with the patient in the lateral decubitus position so that the probe recorded from the nondependent side. Successful recordings were made in 20 patients, in 8 of 20 patients there were embolic signals, which ranging from 1 to 200. In all eight patients, signals were recorded during impaction of a cemented component or after relocation of the hip. Only one patient showed evidence of emboli with impaction of the acetabulum component. In two patients there were 150 and 200 embolic signals: in both mild respiratory symptoms developed. One patient became overtly agitated during a flurry of emboli. Cerebral microemboli can occur during total hip arthroplasty. Whether this contributes to changes in postoperative cognitive function is unknown.
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In all eight patients, signals were recorded during impaction of a cemented component or after relocation of the hip. Only one patient showed evidence of emboli with impaction of the acetabulum component. In two patients there were 150 and 200 embolic signals: in both mild respiratory symptoms developed. One patient became overtly agitated during a flurry of emboli. Cerebral microemboli can occur during total hip arthroplasty. 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R</creatorcontrib><creatorcontrib>BARBUT, D</creatorcontrib><creatorcontrib>HAGER, D</creatorcontrib><creatorcontrib>SHARROCK, N. E</creatorcontrib><title>Intraoperative cerebral arterial embolization during total hip arthroplasty</title><title>Anesthesiology (Philadelphia)</title><addtitle>Anesthesiology</addtitle><description>Fat embolism to the pulmonary circulation is known to occur during total hip arthroplasty, especially during insertion of a cemented femoral component. Fat and air bubbles may enter the systemic circulation via a patent foramen ovale or through pulmonary circulation. To determine whether microemboli to the brain were occurring during total hip arthroplasty, 23 patients underwent transcranial Doppler assessment of emboli to the middle cerebral artery during total hip arthroplasty. Surgery was performed with the patient in the lateral decubitus position so that the probe recorded from the nondependent side. Successful recordings were made in 20 patients, in 8 of 20 patients there were embolic signals, which ranging from 1 to 200. In all eight patients, signals were recorded during impaction of a cemented component or after relocation of the hip. Only one patient showed evidence of emboli with impaction of the acetabulum component. In two patients there were 150 and 200 embolic signals: in both mild respiratory symptoms developed. One patient became overtly agitated during a flurry of emboli. Cerebral microemboli can occur during total hip arthroplasty. Whether this contributes to changes in postoperative cognitive function is unknown.</description><subject>Adult</subject><subject>Aged</subject><subject>Arthroplasty, Replacement, Hip</subject><subject>Biological and medical sciences</subject><subject>Cognition Disorders - etiology</subject><subject>Comorbidity</subject><subject>Embolism, Fat - complications</subject><subject>Embolism, Fat - diagnostic imaging</subject><subject>Female</subject><subject>Humans</subject><subject>Intraoperative Complications</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Middle Cerebral Artery - diagnostic imaging</subject><subject>Orthopedic surgery</subject><subject>Prospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. 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Graft diseases</topic><topic>Ultrasonography, Doppler, Transcranial</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>EDMONDS, C. R</creatorcontrib><creatorcontrib>BARBUT, D</creatorcontrib><creatorcontrib>HAGER, D</creatorcontrib><creatorcontrib>SHARROCK, N. E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Anesthesiology (Philadelphia)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>EDMONDS, C. R</au><au>BARBUT, D</au><au>HAGER, D</au><au>SHARROCK, N. 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Surgery was performed with the patient in the lateral decubitus position so that the probe recorded from the nondependent side. Successful recordings were made in 20 patients, in 8 of 20 patients there were embolic signals, which ranging from 1 to 200. In all eight patients, signals were recorded during impaction of a cemented component or after relocation of the hip. Only one patient showed evidence of emboli with impaction of the acetabulum component. In two patients there were 150 and 200 embolic signals: in both mild respiratory symptoms developed. One patient became overtly agitated during a flurry of emboli. Cerebral microemboli can occur during total hip arthroplasty. Whether this contributes to changes in postoperative cognitive function is unknown.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott</pub><pmid>10910475</pmid><doi>10.1097/00000542-200008000-00006</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record>
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subjects	Adult Aged Arthroplasty, Replacement, Hip Biological and medical sciences Cognition Disorders - etiology Comorbidity Embolism, Fat - complications Embolism, Fat - diagnostic imaging Female Humans Intraoperative Complications Male Medical sciences Middle Aged Middle Cerebral Artery - diagnostic imaging Orthopedic surgery Prospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Ultrasonography, Doppler, Transcranial
title	Intraoperative cerebral arterial embolization during total hip arthroplasty
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