Cement implantation syndrome
OVERVIEW
- cement = methylmethacrylate = acrylic polymer
- syndrome = embolism of fat, bone, marrow, clot, blood and methylmethacrylate
- embolism -> increased PVR -> RVF -> decreased LV preload -> hypotension -> cardiovascular collapse
CLINICAL FEATURES
- most common after femoral stem cement insertion and relocation of THJR
- hypotension
- hypoxia
- decreased ETCO2
- cardiovascular collapse (2% of THJR)
- patients with a PFO -> MI, stroke, death
MANAGEMENT
Intraoperative
- measure BP frequently
- volume load prior to cementing
- increase FiO2
- stop volatiles just prior
- stop N2O
- use alpha-agonists
ICU
- supportive
- protect right ventricle
Prevention
- use non-cemented prostheses
- pulse lavage
- decreased cement pressure
- suction applied to bone cavity to evacuate air and fat (most important)
- if have a high ASA -> tolerates embolism worse
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC