A Case of Fatal Pulmonary Bone-Marrow and Fat Embolism following Insertion of Cemented Femoral Neck Prosthesis

• Published in: Nihon Rinshō Masui Gakkai shi Vol. 19; no. 1; pp. 56 - 59
• Main Authors: TAKENAKA, Ichiro, YAMAMOTO, Toshinori, NAKURA, Nariaki, KADOYA, Tatsuo, SETO, Atsushi
• Format: Journal Article
• Language: English
• Published: THE JAPAN SOCIETY FOR CLINICAL ANESTHESIA 1999
• Subjects: Bone cement; Femoral neck prosthetic replacement; Pulmonary embolism
• ISSN: 0285-4945; 1349-9149
• DOI: 10.2199/jjsca.19.56

A 84-year-old woman underwent femoral neck prosthetic replacement for the left femoral neck fracture. Anesthesia was maintained with nitrous-oxide and sevoflurane in oxygen. Immediately after bone cement was injected into the femoral canal and the implant was inserted, the patient became hypotensive and cardiac arrest ensued. The patient was successfully resuscitated, but the cardiovascular status remained unstable and large doses of epinephrine and dopamine were needed to maintain blood pressure. Her circulatory status gradually deteriorated despite of aggressive intervention, and she eventually died 9 hours after the cardiac arrest. Postmortem examination revealed massive pulmonary embolism of bone marrow and fat, while no evidence of an acute myocardial infarction was found.