133. Ursachen intraoperativer Herzund Kreislaufkomplikationen bei prothetischem H�ftgelenksersatz

Abstract

Summary. Cardiac arrhythmias during hip-joint replacement are caused by monomers of methyl methacrylate from the bone cement. Both the amount of MMA monomer that is released into the bloodstream and the fall in blood pressure are dependent on the extracorporeal polymerization time (mixing time). Although prolongation of the mixing time reduces the frequency of intraoperative hypotension, it has no effect on intraoperative fat embolism. The temporal course and extent of effect of MMA monomer. In 3000 cases, implantation was effected with no monomer-induced lethal complications.

Methyl methacrylate [MAK Value Documentation, 1992]

“…Modig et al [5], on the other hand, in clinical studies and Wenda et al [4] in animal studies (see Section 3.1, Effects on Animals) found no correlation between the monomer concentration in central venous blood and the drop in blood pressure. Eggert et al [55] saw agreement between the monomer concentrations in the central venous blood of their patients and the start, maximum and end of the blood pressure drop. Since, however, the prostheses were put in place immediately after application of the cement, the two processes (monomer concentration change and intrafemural pressure fluctuation) cannot be separated.…”

“…They found no significant differences from controls. In another study of 35 patients with coxarthrosis, Eggert et al [55] found with gas chromatographic techniques that no monomer remained in the blood after a single passage through the lungs.…”

“…However, from the nonoccupational sector there are numerous very informative reports of acute cardiocirculatory system disorders (hypotension, sometimes lethal cardiac arrest) mostly in older patients with coxarthrosis after clinical application of cold-polymerizing PMMA bone cement, e.g., [50][51][52][53][54][55]. Some authors consider that MMA is the primary or at least concomitant cause of cardiac arrest in these cases [52,53].…”