High-volume, high-pressure pulsatile lavage during cemented arthroplasty.
To determine the efficacy of high-volume, high-pressure pulsatile lavage in the prevention of cardiopulmonary dysfunction and fat embolism during cemented arthroplasty, we studied twenty-eight mongrel dogs that had had a bilateral cemented arthroplasty. Significant increases in pulmonary-artery pressure and pulmonary vascular resistance, accompanied by decreases in arterial oxygen tension and increases in intrapulmonary shunt fraction (Qs/Qt), characterized cardiopulmonary dysfunction after bilateral cemented arthroplasty when no lavage was used. Low-volume, low-pressure manual lavage did not significantly alter these physiological changes, but there was a significant reduction in the number of fat emboli that were demonstrated in the lungs as compared with the no-lavage group. High-volume, high-pressure pulsatile lavage of the intramedullary cavity after reaming significantly reduced the changes in pulmonary-artery pressure, pulmonary vascular resistance, arterial oxygen tension, and intrapulmonary shunt fraction (Qs/Qt). In the pulsatile-lavage group, the number of fat microemboli that were found in the lungs was reduced to 25.7 per cent of those found in the no-lavage group. We concluded that meticulous high-volume, high-pressure pulsatile lavage reduces both pulmonary physiological derangements and fat emboli during bilateral cemented arthroplasty in dogs.
Byrick
R J
RJ
Department of Anaesthesia, St. Michael's Hospital, Toronto, Ontario, Canada.
Bell
R S
RS
Kay
J C
JC
Waddell
J P
JP
Mullen
J B
JB
D000818:Animals; D001794:Blood Pressure; D001843:Bone Cements / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000503:physiopathology / Q000517:prevention & control; D004285:Dogs; D004620:Embolism, Fat / Q000517:prevention & control; D006622:Hip Prosthesis; D011312:Pressure; D011651:Pulmonary Artery / Q000502:physiology; D011652:Pulmonary Circulation; D007507:Therapeutic Irrigation / Q000379:methods*; D014655:Vascular Resistance
D001843:Bone Cements