Delayed hypoxemia after bone cement insertion during total hip replacement under spinal anesthesia--a case report.
We report a case of delayed hypoxemia in an aged healthy male patient, which developed 2 hours after cementation of the prosthesis in total hip replacement (THR) under spinal anesthesia. The patient was doing well throughout the operation but unfortunately, progressive tachypnea was noted 1 h after he was transferred to the recovery room (i.e. 2 h after the application of bone cement into the femur). An hour further, distinct wheeze was heard bilaterally on auscultation, which signified bronchospasm. Arterial blood gases analysis revealed a low PaO2 of 71 mmHg and a decrease of oxygen saturation to 91% with supplement of fractional oxygen of 35%. Aerosolization of bronchodilator with terbutaline was administered and supplemental fractional oxygen was increased to 50%. Although wheezing soon subsided, tachypnea and desaturation persisted. He was then transferred to the surgical intensive care unit for further management. Ventilation-perfusion lung scan was performed, which was suggestive of multiple pulmonary embolism.
Hong
Chian-Lang
CL
Department of Anesthesia, Chang Gung Memorial Hospital at Chia Yi, No. 6, Sec West, Chia Pu Road, Putz City, Chia Yi, Taiwan, R.O.C.
Liu
Hung-Pin
HP
Wu
Chung-Yuan
CY
Ho
Angie C Y
AC
Shyr
Ming-Hwang
MH
Wong
Chung-Hang
CH
Chun
Han See
HS
D000368:Aged; D000775:Anesthesia, Spinal; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001843:Bone Cements / Q000009:adverse effects*; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology
D001843:Bone Cements