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.
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.
Chian-Lang
CL
Hong
Hung-Pin
HP
Liu
Chung-Yuan
CY
Wu
Angie C Y
AC
Ho
Ming-Hwang
MH
Shyr
Chung-Hang
CH
Wong
Han See
HS
Chun
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