Key result
Intramedullary instrumentation of long bones for lung cancer metastases resulted in significant intraoperative cardiorespiratory events in 5 of 34 procedures (14.7%), including one fatality.
Observational (n=32)
No
Despite diminished pulmonary reserve in lung cancer patients, significant clinical manifestations of cardiorespiratory and vascular dysfunction during intramedullary instrumentation are relatively uncommon and mostly manageable.
Requires caution with intramedullary nailing in lung cancer metastases; leaves open optimal risk mitigation in prospective studies.
BACKGROUND: Instrumentation, particularly reaming, of the long bones carries the risk of embolic phenomenon. Emboli may result in pulmonary injury, which is usually manifested by desaturation. This pulmonary injury may be particularly relevant if there is diminished pulmonary reserve due to pre-existing lung disease such as lung carcinoma. In extreme cases, this can result in cardiac arrest intraoperatively. PATIENTS AND METHODS: We reviewed 34 consecutive operations that involved instrumentation of long bones for metastases of lung carcinoma. RESULTS: Desaturation developed during 1 procedure, and there was hypotension in 5 patients. In addition, cardiac arrest occurred intraoperatively in 1 patient, which was the only fatality. INTERPRETATION: This study has shown that while emboli during femoral instrumentation may be common, significant clinical manifestations of this phenomenon are uncommon.
No takes yet. Share an insight, caveat, or question.
Clayer et al. (2007) conducted an observational in Lung carcinoma metastases in long bones (n=32). Intramedullary instrumentation was evaluated on Significant intraoperative cardiorespiratory and vascular events (desaturation, hypotension, or cardiac arrest). Intramedullary instrumentation of long bones for lung cancer metastases resulted in significant intraoperative cardiorespiratory events in 5 of 34 procedures (14.7%), including one fatality.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: