Hemodynamic and Arterial Blood Gas Parameters during Cemented Hip Hemiarthroplasty in Elderly Patients

Abstract

Background: <br/> <span style="font-size: xx-small; font-family: ArialMT;">Patients undergoing cemented hip hemiarthroplasty may develop bone cement implantation </span>syndrome (BCIS) which is a leading cause of intraoperative complications. The purpose of this study was to evaluate cardiovascular changes during cemented hip hemiarthroplasty in elderly patients. <br/>Methods: <br/> <span style="font-size: xx-small; font-family: ArialMT;">Cemented hip hemiarthroplasty was performed on 72 patients with femoral neck fracture. All patients were </span>catheterized with a radial artery catheter to assess mean arterial pressure (MAP) and arterial blood gas (ABG) in these time points: just before cementation, just after cementation (0<span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;">th</span></span><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;">), 5 min (5</span></span><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;">th</span></span><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;">) and 10 min (10</span></span><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;">th </span></span><span style="font-size: xx-small; font-family: ArialMT;">) after cementation, and at </span>the end of surgery (END). Also, systolic and diastolic blood pressure (SBP & DBP), heart rate and any arrhythmia or cardiac arrest was evaluated. <br/> Results: <br/> <span style="font-size: xx-small; font-family: ArialMT;">Seventy-two patients (33 females, 39 males; mean age: 66.8±7 years) were evaluated. All parameters </span>changed during cementation with a significant drop in MAP, SBP, and DBP immediately after cementation and pH and base excess decreased significantly (<em><span style="font-size: xx-small; font-family: Arial-ItalicMT;"><em><span style="font-size: xx-small; font-family: Arial-ItalicMT;">P</span></em></span></em><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;"><0.001) with no changes in O2 saturation. Mean heart rate rose until the 5</span></span><span style="font-size: xx-small; font-family: ArialMT;"><span style="font-size: xx-small; font-family: ArialMT;">th </span></span><span style="font-size: xx-small; font-family: ArialMT;">and </span>then decreased dramatically with no bradycardia presentation. During cementation, 12 patients showed arrhythmia, but no cardiac-arrest was observed. <br/>Conclusions: <br/> <span style="font-size: xx-small; font-family: ArialMT;">Under strict observation of a anesthesiology care team, hemiarthroplasty can be a safe method for </span>femoral neck fracture in elderly osteoporotic patients without severe cardiopulmonary compromise.