MONITORING OF BONE-MARROW RELEASE AND CAR DIOPULMONARY CHANGES IN THEFAT-EMBOLISM SYNDROME

After long bone fractures, as well as hip or knee total arthroplasty, the increase in intramedullary pressure induces bone marrow release in to the circulation in more than 90 % of patients. Three to four percen t of the patients reveal fat embolism syndrome with pulmonary and cere bral involvement and a petechial rash. In about 20 % of these patients a fulminant and fatal course is;possible. Although fat embolism syndr ome was described more than a century ago, there is still no sufficien t therapeutic strategy. Because of these facts we try to prevent fat e mbolism syndrome and monitor patients at risk perioperatively. We have evaluated different diagnostic methods and monitoring facilities and recommend pulse oximetry, capnometry, EGG, blood pressure controls and , if indicated, blood gas analyses for perioperative monitoring. Patie nts at risk and patients who are suffering from fat embolism syndrome require more intensive monitoring, such as transesophageal echocardiog raphy and a pulmonary artery catheter to obtain more detailed informat ion about the hemodynamic and oximetric variables. Furthermore, these patients must be admitted to an intensive care unit.