During total hip replacement, marked reductions in arterial blood pressure and oxygen tension correlated significantly with the release of tissue-thromboplastic products into the pulmonary circulation.
Observational (n=13)
Does the release of tissue-thromboplastic products, fat embolism, or acrylic monomers cause arterial hypotension and hypoxaemia during total hip replacement?
Intraoperative hypotension and hypoxaemia during total hip replacement are primarily driven by the release of tissue-thromboplastic products rather than fat embolism or acrylic monomers.
Thirteen patients submitted to total hip replacement surgery by the Charnley technique were studied. Operations were performed under epidural analgesia with the patients awake and breathing air. During the surgical procedure, the magnitude of tissue‐thromboplastic activity, the amount of fat globules, the presence of bone marrow cells and the concentrations of acrylic monomers were determined in the pulmonary arterial blood. Simultaneously, arterial blood gases and blood pressure were monitored. Marked reductions of the arterial blood pressure and arterial oxygen tension occurred after impaction of the femoral prosthesis, and minor depressions appeared after insertion of the acetabular prosthesis. A significant correlation was found between the release of tissue‐thromboplastic products into the pulmonary circulation, i.e., products that initiate intravascular coagulation and the circulatory and respiratory reactions. The pulmonary fat droplets, per se, seem to be of minor importance, and the release of acrylic monomers is probably of no importance for these reactions. ZUSAMMENFASSUNG 13 Patienten, bei denen ein totaler Hüftgelenksersatz nach Charnley durchgeführt wurde, dienten als Grundlage dieser Stuide. Die Operationen erfolgten in Epiduralanaesthesie, die Patienten waren wach und atmeten Luft. Während des Eingriffes wurden das Ausmaß der thromboplastischen Gewebsaktivität, die Menge der Fett‐tröfchen, das Vorhandensein von Knochenmarkszellen und die Konzentration der Akrylmonomeren kontinuierlich im Pulmonalarterienblut bestimmt. Gleichzeitig wurden arterielle Blutgase und Blutdruck registrert. Nach dem Einzementieren der Femoralprothese kam er reglmäßig zu ausgeprägter Atem‐ und Kreislauf‐depression, nach Einsetzen der Azetabularprothese traten geringere Dämpfungen afu. Als Resultat unserer Untersuchungen steht fest, daß die zirkulatorischen und respiratorischen Phänomene hauptsächlich durch die Freisetzung gewebsthrombopulasticher Produkte in dne Kreislauf verursacht werden, nämlich Produkte, die zu intravaskulärer Koagulation (Aggregation von Thrombozyten und Fibrin) führen. Die Fett‐tröfchen an sich sind von geringer Bedeutung, die Freisetzung von Akrylmonomeren wahrscheinlich irrelevant.
Modig et al. (Sat,) conducted a observational in Total hip replacement surgery (n=13). Total hip replacement surgery (impaction of femoral prosthesis) was evaluated on Arterial blood pressure and arterial oxygen tension reductions. During total hip replacement, marked reductions in arterial blood pressure and oxygen tension correlated significantly with the release of tissue-thromboplastic products into the pulmonary circulation.
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