Tierexperimentelle untersuchungen zur pathogenese intraoperativer Kreislauf- und atmungsreaktionen bei der implantation sogenannter knochenzemente in die markhöhle eines röhrenknochens

Abstract

This paper shows the effects of the increase in pressure in the medullary cavity in the blood circulation and the respiration observed during implantation of bone cement with animal experiments. The pathomechanism is also examined. The reactions of the respiration and the circulation, when observed, resulted in the intramedullary increase in pressure. These are nerval reflexes caused by the innervation in the medullary cavity and are not reactions of the monomer, which may come into the circulation during the polimerization of bone cement. These reactions are very different from those caused by the fatal obstruction of the pulmonary blood vessels through bone marrow ingredients. This is the effect of an insufficient prevention of increase in medullary pressure during cement implantation.

Cardiovascular reactions to intramedullary reaming of long bones in dogs

“…Nervous regulation of the circulation is rapid, and hypotension may even be accompanied by bradycardia due to vagal stimulation. This assumption is also in agreement with experimental evidence that intramedullary manipulation may induce neurogenic hypotension (28).…”

Intraoperativer Nachweis von Luftembolien und korpuskularen Embolien mit Hilfe der Pulsoximetrie und Kapnometrie

“…(15,32). Klinisch manifestiert sich das Geschehen durch akute Belastungen des kleinen Kreislaufs (Anstieg des Pulmonalarteriendruckes), Abfall des arteriellen Systemdrukkes, Abfall des arteriellen 02-Partialdruckes (intrapulmonaler Shunt, vermehrte periphere Sauerstoffausschöpfung) und Anstieg des arteriellen COz-Partialdruckes, wie intraoperative hämodynamische Studien insbesondere nach Einzementierung der Femurschaftprothese zeigen konnten (1,23,24,30,31,(35)(36)(37)43). Kardiale Arrhythmien wurden ebenfalls in diesem Zusammenhang beschrieben (5,37).…”

The Bone Cement Hypercoagulation Syndrome: Pathophysiology, Mortality, and Prevention

“…65,70,71 Early during surgery, preparation and mechanical manipulation of the femoral shaft both trigger moderate autonomic reflexes while embolized cell clusters from the surgical site mediate vasoactive substances, the consequences of which contribute to pulmonary hypertension. 57,58,72,73 Bone Cement Released Methyl Methacrylate Monomer and Impact on the Coagulation System Almost 70 years have passed since monomeric methyl methacrylate (MMA) was found to cause fatal reactions during hip replacement. In the early era of bone cement implantation, studies investigating MMA found that respiratory arrest was the primary cause of death rather than cardiac arrest.…”

“…Early during surgery, preparation and mechanical manipulation of the femoral shaft both trigger moderate autonomic reflexes while embolized cell clusters from the surgical site mediate vasoactive substances, the consequences of which contribute to pulmonary hypertension. 57 , 58 , 72 , 73 …”