Cerebral embolization presenting as delayed, severe obtundation in the postanesthesia care unit after total hip arthroplasty

Mayo Clinic Proceedings

Volumn 75, Issue 11, 2000, Pages 1209-1213

  Ott, Michael C ^a   Meschia, James F ^b,d   Mackey, David C ^b   Brodersen, Mark P ^b   Burger, Charles ^c   Dan Echols, J ^b   Fenton, Douglas S ^d  

^a Div of Pulmon/Critical Care Med   (United States)

^b Department of Neurology ^*  (United States)

^c Division of General Internal Medicine   (United States)

^d MAYO CLINIC   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADRENALIN; AMLODIPINE; ANESTHETIC AGENT; BENAZEPRIL; BUPIVACAINE; ISOFLURANE; LEVOTHYROXINE; MORPHINE; NITROUS OXIDE; ONDANSETRON; PROPOFOL;

ADULT; ARTICLE; BRAIN EMBOLISM; CASE REPORT; DIFFERENTIAL DIAGNOSIS; FAT EMBOLISM; FEMALE; HIP SURGERY; HUMAN; HYPERTENSION; HYPOTHYROIDISM; NEUROLOGICAL COMPLICATION; NUCLEAR MAGNETIC RESONANCE IMAGING; OSTEOARTHRITIS; POSTOPERATIVE COMPLICATION; POSTOPERATIVE NAUSEA; TOTAL HIP PROSTHESIS;

EID: 0033756893     PISSN: 00256196     EISSN: None     Source Type: Journal    
DOI: 10.4065/75.11.1209     Document Type: Article

References (35)

1. Mines R, Barush PC. Watrous G, O'Connor T. Complications occurring in the postanesthesia care unit: a survey. Anesth Analg. 1992:74:503-509.
2. Zelcer J, Wells DG. Anaesthetic-related recovery room complications. Anaeslh Intensive Care. 1987; 15:168-174.
3. de Mello WF. Tully A, Restall J. Morbidity in the postanesthesia care unit |letter|. Anesth Analg. 1992;75:640.
4. Van der Walt JH, Webb RK, Osborne GA, Morgan C, Mackay P. The Australian Incident Monitoring Study: recovery room incidents in the first 2000 incident reports. Anaesth Intensive Care. 1993:21:650-652.
5. Mecca RS. Postoperative recovery. In: Barash PG, Cullen BF, Stoelting RK, eds. Clinical Anesthesia. 3rd ed. Philadelphia, Pa: Lippi ncott-Raven ; 1997:1279-1303.
6. Mathew JP, Rosenbaum SH, O'Connor T, Barash PG. Emergency trachéal intubation in the postanesthesia care unit: physician error or patient disease? Anesth Analg. 1990:71:691 -697.
7. Daley MD, Norman PH, Colmenares ME, Sandier AN. Hypoxaetnia in adults in the post-anaesthesia care unit. Can J Anaeslh. 1991:38:740-746.
8. Rose DK, Cohen MM, Wigglesworth DF, DeBoer DP. Critical respiratory events in the postanesthesia care unit: patient, surgical, and anesthetic factors. Anesthesiology. 1994:81:410-418.
9. Johnson A, Bengtsson M, Soderlind K, Lofstrom JB. Influence of intrathecal morphine and naloxone intervention on postoperative ventilatory regulation in elderly patients. Acta Anaesthesiol Scand. 1992:36:436-444.
10. Jones RD, Jones JG. Intrathecal morphine: naloxone reverses respiratory depression bul not analgesia. Br Med J. 1980:281:645-646.
11. Limburg M. Wijdicks EF, Li H. Ischémie stroke after surgical procedures: clinical features, neuroimaging, and risk factors. Neurology. 1998:50:895-901.
12. Takahashi M, Suzuki R, Osakabe Y, et al. Magnetic resonance imaging findings in cerebral fat embolism: correlation with clinical manifestations. J Trauma. 1999;46:324~327.
13. Stoeger A, Daniaux M, Felber S, Stockhammer G, Aichner F, zur Nedden D. MRI findings in cerebral fat embolism. Eur RadioJ. 1998;8:1590-1593.
14. Bardana D, Rudan J, Cervenko F, Smith R. Fat embolism syndrome in a patient demonstrating only neurologic symptoms. Can J Surg. 1998;41:398-402.
15. Yoshida A, Okada Y, Nagata Y, Hanaguri K, Morio M. Assessment of cerebral fat embolism by magnetic resonance imaging in the acute stage. J Trauma. 1996;40:437-440.
16. Satoh H, Kurisu K, Ohtani M, et al. Cerebral fat embolism studied by magnetic resonance imaging, transcranial Doppler sonography, and single photon emission computed tomography: case report. J Trauma. 1997:43:345-348.
17. Forteza AM, Koch S, Romano JG, et al. Transcranial Doppler detection of fat emboli. Stroke. 1999:30:2687-2691.
18. Heine TA, Halambeck BL, Mark JB. Fatal pulmonary fat embolism in the early postoperative period. Anesthesiolog\. 1998:89:15891591.
19. Findlay JM, DeMajo W. Cerebral fat embolism. Can Med Assoc J. 1984:131:755-757.
20. Font MO, Nadal P, Bertran A. Fat embolism syndrome with no evidence of pulmonary involvement [letter]. Crit Care Med. 1989; 17:108-109.
21. Jacobs S, al Thagafi MY, Biary N, Hasan HA, Sofi MA, Zuleika M. Neurological failure in a patient with fat embolism demonstrating no lung dysfunction [letter]. Intensive Care Med. 1996:22:1461.
22. ten Duis HJ. The fat embolism syndrome. Injury. 1997:28:77-85.
23. Christie J. Robinson CM, Pell AC, McBirnie j", Burnett R. Transcardiac echocardiography during invasive intramedullary procedures. J Bone Joint Surg Br. 1995:77:450-455.
24. Lafont ND, Kalonji MK, Barre J, Guillaume C, Boogaerts JG. Clinical features and echocardiography of embolism during cemented hip arthroplasty. Can J Anaesth. 1997:44:112-117.
25. Ereth MH, Weber JG, Abel MD, et al. Cemented versus noncemented total hip arthroplasty-embolism, hemodynamics, and intrapulmonary shunting. Mayo Clin Proc. 1992:67:1066-1074.
26. Bulger EM, Smith DG, Maier RV, Jurkovich GJ. Fat embolism syndrome: a 10-year review. Arch Surg. 1997;132:435-439.
27. Byrick RJ. Cement implantation syndrome: a time limited embolie phenomenon [editorial]. Can JAnaesth. 1997:44:107-111.
28. Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59:17-20.
29. Etchells EE, Wong DT, Davidson G, Houston PL. Fatal cerebral fat embolism associated with a patent foramen ovale. Chest. 1993; 104:962-963.
30. Pell AC, Hughes D, Keating J, Christie J, Busuttil A, Sutherland GR. Brief report: fulminating fat embolism syndrome caused by paradoxical embolism through a patent foramen ovale. N Engl J Med. 1993:329:926-929.
31. Fabian TC. Unravelling the fat embolism syndrome [editorial]. N Engl J Med. 1993:329:961-963.
32. Byrick RJ, Müllen JB, Mazer CD, Guest CB. Transpulmonary systemic fat embolism: studies in mongrel dogs after cemented arthroplasty. Am J Re.spir Crit Care Med. 1994; 150(5, pt 1 ): 14161422.
33. Nijsten MW, Hamer JP, ten Duis HJ, Posma JL. Fat embolism and patent foramen ovale [letter]. Lancet. 1989:1:1271.
34. Schonfeld SA, Ploysongsang Y, DiLisio R, et al. Fat embolism prophylaxis with corticosteroids: a prospective study in high-risk patients. Ann Intern Med. 1983:99:438-443.
35. Kallenbach J, Lewis M, Zaltzman M, Feldman C, Orford A, Zwi S. 'Low-dose' corticosteroid prophylaxis against fat embolism. J Trauma. 1987:27:1173-1176.