Perioperative pulmonary circulatory changes during bilateral total hip arthroplasty under regional anesthesia.
OBJECTIVE
The transient and rarely clinically relevant effect of bone and cement embolization during unilateral joint arthroplasty is a known phenomenon. However, available studies do not address events surrounding bilateral total hip arthroplasties, during which embolic load is presumably doubled. To elucidate events surrounding this increasingly used procedure and assess the effect on the pulmonary hemodynamics in the intraoperative and postoperative periods, we studied 24 subjects undergoing cemented bilateral total hip arthroplasty during the same anesthetic session.


METHODS
Twenty-four patients without previous pulmonary history undergoing cemented bilateral total hip arthroplasty under controlled epidural hypotension were enrolled. Pulmonary artery catheters were inserted and hemodynamic variables were recorded at baseline, 5 mins after the implantation of each hip joint, 1 hr and 1 day after surgery. Mixed venous blood gases and complete blood counts were analyzed at every time point.


RESULTS
An increase in pulmonary vascular resistance was observed after the second but not the first hip implantation when compared with values at incision. Pulmonary vascular resistance remained elevated 1 hr after surgery. Pulmonary artery pressures were significantly elevated on postoperative day 1 compared with those at baseline. The white blood cell count increased in response to the second hip implantation but not the first compared with incision.


CONCLUSIONS
The embolization of material during bilateral total hip arthroplasty is associated with prolonged increases in pulmonary artery pressures and vascular resistance, particularly after completion of the second side. Performance of bilateral procedures should be cautiously considered in patients with diseases suggesting decreased right ventricular reserve.
Memtsoudis
Stavros G
SG
Department of Anesthesiology, Hospital for Special Surgery, New York, NY 10021, USA. MemtsoudisS@hss.edu
Salvati
Eduardo A
EA
Go
George
G
Ma
Yan
Y
Sharrock
Nigel E
NE
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000765:Anesthesia, Conduction; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001794:Blood Pressure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011651:Pulmonary Artery / Q000502:physiology; D011652:Pulmonary Circulation; D014655:Vascular Resistance
Can J Anaesth. 1997 Feb;44(2):112-7
9043721
Crit Care Med. 2007 Nov;35(11):2582-6
17828036
J Arthroplasty. 2006 Oct;21(7):931-4
17027533
Acta Anaesthesiol Scand. 1975;19(3):219-37
241194
Clin Orthop Relat Res. 2008 Nov;466(11):2617-27
18704616
Anesth Analg. 2001 Dec;93(6):1460-5, table of contents
11726423
Anesth Analg. 2001 Jan;92(1):49-55
11133599
Can J Anaesth. 1994 Sep;41(9):850-3
7955002
J Cardiovasc Med (Hagerstown). 2008 Mar;9(3):277-81
18301146
Int Orthop. 1997;21(4):253-8
9349963
J Am Acad Orthop Surg. 2002 May-Jun;10(3):217-21
12041943
Biometrics. 1986 Mar;42(1):121-30
3719049
Reg Anesth Pain Med. 2008 Jan-Feb;33(1):17-23
18155052
Minerva Anestesiol. 2002 Jun;68(6):537-47
12105410
Acta Orthop Scand. 1996 Feb;67(1):91-107
8615115
Anesth Analg. 1996 Jun;82(6):1225-9
8638795
J Bone Joint Surg Am. 1991 Feb;73(2):271-7
1993721
Anaesthesia. 1989 Feb;44(2):149-53
2929940