Summary
Decreases in arterial oxygen tension (PaO2) and increased venous admixture (Qs/Qt) occur with acrylic cement insertion. Mean decreases in PaO2 of 17.5 mm Hg occurred in this study of 41 patients. Qs/Qt increased by 7 per cent to 16.0 per cent during general anaesthesia with N2O.O2 - Halothane (4L:2L:1%) and d-tubocurarine. Assessment of pulmonary gas exchange using PaO2, A-aDO2, a-ADCO2 and acid-base studies using arterial and central venous blood samples in 16 patients suggest that both ventilation-perfusion mismatch and pulmonary arterio-venous shunts occur transiently after acrylic bone cement is used. Stable central venous oxygen tensions and normal heart sounds (Doppler), heart rhythm and stable blood pressure suggest that cardiac output changes, if any, are minimal.
Patients for total hip replacement are most commonly females, obese, in their 60s and often have airway or cardiovascular disease. General anaesthesia must be conducted with particular attention to prevention of hypovolaemia by adequate rehydration and aggressive blood transfusions, prior to cement insertion into the vented femoral shaft. Inspired oxygen tension should be increased to 50 per cent prior to cement insertion. The oxygen tension may be returned to the pre-insertion value 15 minutes after cement insertion. Fumes from the polymerizing acrylic cement may cause some liver dysfunction but insufficient data is available to confirm this.
RéSUMé
Des baisses de la saturation artérielle en oxygène ( PaO2 ) et une élévation du shunt veineux (Qs/Qt) accompagnent l’application de l’acrylique. Une baisse moyenne de PaO2 de 17.5 mm Hg fut observée dans cette étude de 41 patients. Pendant l’anesthésie générale au N2O-O2 - halothane (4L:2L:1%) et d’tubocurarine, le Qs/Qt s’est élevé de 7 pour cent à 16 pour cent, L’évaluation des échanges gazeux pulmonaires, d’après l’étude des PaO2, AaDO2 et de l’équilibre acido-basique avec échantillons artériels et veineux mixtes chez 16 patients démontre l’existence transitoire de déséquilibre entre la ventilation et la perfusion et de shunt artério-veineux, secondaire à l’emploi d’acrylique. La stabilité de la pression partielle d’oxygène du sang veineux mixte, les bruits et le rythme cardiaque normaux (Doppler) et une pression artérielle stable attestent du peu de changement dans le débit carriaque.
Les patients sujets à une prothèse totale de la hanche sont le plus souvent des femmes obéses, sexagénaires et porteuses de maladies pulmonaires ou cardiovasculaires. L’anesthésie générale doit étre administree avec attention speciale a la prevention de l’hypovolemie: remplacement liquidien adequat et attitude agressive vis-a-vis les transfusions sanguines avant I’application de l’acrylique a l’intrieur du canal beant de l’os femoral. La pression partielle de l’oxygene du melange inspire devrait être augmentée à 50 pour cent avant l’application de l’acrylique; on pourra revenir à la concentration première, quinze minutes après l’application. Les vapeurs émises par la polymérisation de l’acrylique pourraient provoquer une dysfonction hépatique, mais les données sont trop peu nombreuses pour confirmer ce fait.
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Turnbull, K.W., Berezowskyj, J.L., Poulsenl, J.B. et al. General anaesthesia and total hip replacement. Canad. Anaesth. Soc. J. 21, 546–556 (1974). https://doi.org/10.1007/BF03006016
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DOI: https://doi.org/10.1007/BF03006016