In the Literature

Summary of "Bone Cement and Its Anesthetic Complications: A Narrative Review"

Summary published August 8, 2023

Summary by Paul A. Lefebvre, JD

Journal of Clinical Medicine | March 2023

Al-Husinat L, Jouryyeh B, Al Sharie S, Al Modanat Z, Jurieh A, Al Hseinat L, Varrassi G. Bone Cement and Its Anesthetic Complications: A Narrative Review. J Clin Med. 2023 Mar 7;12(6):2105. doi: 10.3390/jcm12062105. PMID: 36983108; PMCID: PMC10056839.

doi: https://doi.org/10.3390/jcm12062105

  • In this narrative review article, the authors analyzed information obtained from various studies to inform readers about bone cement implantation syndrome (BCIS), including its incidence rate, patient-risk factors, etiology, and clinical presentation. The authors also discuss strategies to prevent BCIS, and how anesthesia professionals can manage patients who experience this complication.
  • While clinical manifestations of BCIS range from minor hypotension to cardiac arrest, most studies suggested patients experienced right ventricular failure originating from increased pulmonary vascular resistance during the onset of BCIS. Three retrospective studies of patients undergoing hemiarthroplasty reported BCIS incidence rates of 28%, 31%, and 37%. A fourth study, which included only cancer patients undergoing hip arthroplasties, reported BCIS incidence rate of 74%.
  • The authors note several theories relating to the etiology and pathophysiology of BCIS were present in the literature, including complement activation, histamine release, and circulating methyl methacrylate monomers. In recent years, most studies have focused on embolus-mediated model to explain the BCIS process.
  • The authors determined there is insufficient information in the literature to conclude whether spinal anesthesia or general anesthesia should be the preferred anesthetic technique for surgeries involving the use of bone cement. Accordingly, anesthesia professionals should identify patients at high risk for experiencing BCIS prior to surgery. The authors recommend implementing a number of prevention strategies, such as optimizing high-risk patients’ cardiovascular reserves, effectively communicating with the surgeon, and being attentive to hemodynamic changes during critical phases of the procedure.
  • If BCIS is suspected, the authors encourage anesthesia professionals to respond with aggressive supportive therapy, beginning with prompt resuscitative measures and use of direct-acting agonists to maintain hemodynamic stability. The authors suggest implementing appropriate interventions to address right ventricle failure can improve outcomes for patients experiencing cardiovascular collapse secondary to BCIS.