Bone cement implantation syndrome during hip replacement in a patient with pemphigus and Parkinson’s disease: A case report

Abstract

BACKGROUND

Bone cement implantation syndrome (BCIS) is characterized by hypotension, arrhythmia, diffuse pulmonary microvascular embolism, shock, cardiac arrest, any combination of these factors, or even death following bone cement implantation.

CASE SUMMARY

An 80-year-old patient with pemphigus and Parkinson’s disease underwent total hip replacement under spinal subarachnoid block and developed acute pulmonary embolism after bone cement implantation. The patient received mask mechanical ventilation with a continuous intravenous infusion of adrenaline (2 μg/mL) at a rate of 30 mL/h. Subsequently, the symptoms of BCIS were markedly alleviated, and the infusion rate of adrenaline was gradually reduced until the infusion was completely stopped 45 min later. The patient was then transferred to the Department of Orthopedics, and anticoagulation therapy began at 12 h postoperatively. No other complications were observed.

CONCLUSION

This is a rare case of BCIS in a high-risk patient with pemphigus and Parkinson’s disease.

Keywords: Bone cement implantation syndrome; Pemphigus; Parkinson’s disease; Pulmonary embolism; Case report

Core Tip: Bone cement implantation syndrome (BCIS) is an important cause of death and disability during the perioperative period of total hip replacement. The present patient with pemphigus and Parkinson's disease had a higher risk of BCIS than the general population due to pathophysiological changes and current medications. Therefore, the choice of anesthetic method for such patients must take full account of their current conditions. In addition, vital signs must be closely monitored intraoperatively to prevent the occurrence of BCIS.