DOES THE USE OF METHYLMETHACRYLATE CEMENT IN TOTAL SHOULDER REPLACEMENT INDUCE HEMODYNAMIC OR PULMONARY INSTABILITY

Study Objective: To investigate whether the use of methylmethacrylate cement causes hemodynamic or pulmonary instability during total should er replacement surgery. Design: Prospective, nonrandomized study. Sett ing: Operating room. Patients: 9 ASA physical status I and II patients . Interventions: A 20-gauge radial artery catheter was placed in the w rist opposite the surgical site. Sedation with midazolam was provided, and a pulmonary artery catheter was placed through an 8.5-Fr introduc er into the patient's right internal jugular vein. Measurements and Ma in Results: Before induction of anesthesia, systolic, diastolic, and m ean arterial blood pressures; heart rate; central venous pressure; sys tolic, diastolic, and mean pulmonary artery pressures; pulmonary capil lary wedge pressure; and thermodilution cardiac output measurements we re obtained. Arterial and mixed venous blood gas samples also were col lected and analyzed for calculation of Qs/Qt. These hemodynamic and pu lmonary parameters were measured again just before cementing of each p rosthesis with methylmethacrylate cement and at 1, 5, 10, and 20 minut es after cementing. There were no statistically significant changes in any of the measured hemodynamic parameters at any time. There was no statistically significant difference in the calculated intrapulmonary shunt fraction. Conclusion: In this study population, the use of methy lmethacrylate for total shoulder replacement was not associated with a dverse hemodynamic events or increased intrapulmonary shunting.