Grade III bone cement implantation syndrome in malignant lung cancer patient: a case report

Pawan Kumar Hamal,Janith Singh,Puspa Raj Poudel

doi:10.1186/s12871-018-0492-x

Pawan Kumar Hamal, Janith Singh + Show 1 more

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https://doi.org/10.1186/s12871-018-0492-x

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Abstract

BackgroundBone cement implantation syndrome is a known complication causing mortality during perioperative period particularly in patients with malignancy. With rise in aging population with malignancy in low income country, the syndrome is more likely to be encountered.Case presentationWe present a case of 66 years old male patient with metastatic bronchogenic carcinoma of lung with pathological proximal femur fracture of left hip that underwent a cemented endoprosthesis under combined spinal epidural anesthesia who succumbed to intraoperative mortality due to grade III bone cement implantation syndrome even after aggressive fluid resuscitation, vasopressor use, and mechanical ventilation.ConclusionsCareful identification of risk factors with aggressive vigilance and intervention in part of surgeons and anesthesia both during intraoperative and postoperative period can mitigate the risk of bone cement implantation syndrome.

Highlights

Bone cement implantation syndrome is a known complication causing mortality during perioperative period in patients with malignancy
There was no agreed definition of bone cement implantation syndrome (BCIS) until it was proposed to be characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery [1]
Three grades of syndrome have been proposed by Donaldson according to blood pressure measurement, degree of hypoxia and consciousness level corresponding to worse prognosis with final grade requiring cardiopulmonary resuscitation [1,2,3]

Summary

Introduction

Bone cement implantation syndrome is a known complication causing mortality during perioperative period in patients with malignancy. Three grades of syndrome have been proposed by Donaldson according to blood pressure measurement, degree of hypoxia and consciousness level corresponding to worse prognosis with final grade requiring cardiopulmonary resuscitation [1,2,3]. Those with advanced age, poor cardiopulmonary reserve, high ASA grade [3], pulmonary hypertension, bony metastasis, osteoporosis, pathological or intertrochanteric fractures, surgeries undergoing cemented prosthesis are implicated to be at increased risk (Table 1) [1, 2].

Results

Conclusion