title: Does the use of methylmethacrylate cement in total shoulder replacement induce hemodynamic or pulmonary instability?
abstract: OBJECTIVE
  To investigate whether the use of methylmethacrylate cement causes hemodynamic or pulmonary instability during total shoulder replacement surgery.
  
  
  METHODS
  Prospective, nonrandomized study.
  
  
  METHODS
  Operating room.
  
  
  METHODS
  9 ASA physical status I and II patients.
  
  
  METHODS
  A 20-gauge radial artery catheter was placed in the wrist opposite the surgical site. Sedation with midazolam was provided, and a pulmonary artery catheter was placed through an 8.5-Fr introducer into the patient's right internal jugular vein.
  
  
  RESULTS
  Before induction of anesthesia, systolic, diastolic, and mean arterial blood pressures; heart rate; central venous pressure; systolic, diastolic, and mean pulmonary artery pressures; pulmonary capillary wedge pressure; and thermodilution cardiac output measurements were obtained. Arterial and mixed venous blood gas samples also were collected and analyzed for calculation of Qs/Qt. These hemodynamic and pulmonary parameters were measured again just before cementing of each prosthesis with methylmethacrylate cement and at 1, 5, 10, and 20 minutes after cementing. There were no statistically significant changes in any of the measured hemodynamic parameters at any time. There was no statistically significant difference in the calculated intrapulmonary shunt fraction.
  
  
  CONCLUSIONS
  In this study population, the use of methylmethacrylate for total shoulder replacement was not associated with adverse hemodynamic events or increased intrapulmonary shunting.
authors.affiliation: Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107.
authors.forename: S
authors.initials: S
authors.lastname: Huffnagle
authors.forename: J L
authors.initials: JL
authors.lastname: Seltzer
authors.forename: M
authors.initials: M
authors.lastname: Torjman
authors.forename: A
authors.initials: A
authors.lastname: Marr
authors.forename: J
authors.initials: J
authors.lastname: Fenlin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002484:Cementation / Q000009:adverse effects*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007595:Joint Prosthesis / Q000379:methods*; D008297:Male; D008768:Methylmethacrylates / Q000009:adverse effects; D008875:Middle Aged; D011652:Pulmonary Circulation / Q000187:drug effects*; D012785:Shoulder Joint / Q000601:surgery*
chemical_list: D008768:Methylmethacrylates