Endogenous cannabinoids are candidates for lipid mediators of bone cement implantation syndrome.
Acute hypotension, hypoxemia, cardiac arrhythmias, cardiac arrest, (or a combination of these), and sudden death are well-recognized complications of the cemented hip arthroplasty procedure. Collectively, these are known as the bone cement implantation syndrome (BCIS). The endogenous cannabinoids, anandamide (ANA) and 2-arachidonylglycerol (2-AG), are reported to be strong vasodilators and play a role in the hypotension associated with hemorrhagic and septic shock. In the present study, a potential role for the endogenous cannabinoids in influencing hemodynamic variables in BCIS was investigated. Thirty-five patients (35 hips) entered a prospective, randomized clinical trial. The patients were divided into two groups. Group 1 comprised 16 patients who had the component inserted using a conventional cementing technique, whereas group 2 consisted of 19 patients who had the femoral component inserted without cement. Blood samples were taken at six consecutive time points: before anesthesia, after reaming the femur, 2 min after insertion of stems with or without cement into the femur, and 10 min, 20, and 30 min after stem insertion. In group 1 (with cement), the mean levels of ANA and 2-AG significantly increased after stem insertion. In a comparison of each group after stem insertion, mean ANA and 2-AG levels in group 1 also significantly differed from those in group 2. By contrast, in group 2 (without cement) neither ANA nor 2-AG levels exhibited a significant increase or change at any point in time. In conclusion, we have shown for the first time that endogenous cannabinoids are candidates for lipid mediators of BCIS.
Motobe
Takashi
T
Department of Orthopaedic Surgery, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Hashiguchi
Teruto
T
Uchimura
Tomonori
T
Yamakuchi
Munekazu
M
Taniguchi
Noboru
N
Komiya
Setsuro
S
Maruyama
Ikuro
I
D000368:Aged; D001095:Arachidonic Acids / Q000378:metabolism; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001794:Blood Pressure; D001843:Bone Cements / Q000627:therapeutic use*; D002186:Cannabinoids / Q000378:metabolism*; D063388:Endocannabinoids; D005260:Female; D005989:Glycerides / Q000378:metabolism; D006331:Heart Diseases / Q000209:etiology*; D006801:Humans; D007022:Hypotension; D050356:Lipid Metabolism; D008297:Male; D008954:Models, Biological; D053284:Polyunsaturated Alkamides; D011446:Prospective Studies; D011475:Prosthesis Failure; D012769:Shock / Q000209:etiology; D013577:Syndrome; D013997:Time Factors; D014665:Vasodilator Agents / Q000494:pharmacology
D001095:Arachidonic Acids; D001843:Bone Cements; D002186:Cannabinoids; D063388:Endocannabinoids; D005989:Glycerides; D053284:Polyunsaturated Alkamides; D014665:Vasodilator Agents; C094503:glyceryl 2-arachidonate; C078814:anandamide